Friday, September 30, 2016

Working hard

I started back at work. Yaaaay! Only 7 mos away! Geeze it took a long time.

My first day back I worked alongside a co worker => ended up with a migraine half way through! Thankfully my migraine med worked and I didn't have to leave work because I needed to take morphine to relieve the pain.

My next shift I was kicked to fend for myself. And WOW what a shift!

At first it flowed well. I had a flow down. Plus there were some nursing students that were paired with ME who I could delegate some tasks to. Too bad they were only there until noon. ARG all by myself. Goodness I thought I was falling out of the nest and having to learn to fly while falling 50 ft to the ground. I felt inept for sure.

Then of course the shit hit the fan after one of my patients (who got thrown on me because a nurse called in sick! - go figure) had physicians coming out of the wood work, popping up and saying that all these stat things needed to occur.

A little back story: my patient ended up at our house because my patient was found by family with what was thought coffee ground emesis and so EMS brought her to MY hospital. Oh ya, and her GCS was 7. But for who knows what they were thinking, did not think stroke considering all signs pointed to stroke.... who knows why though. Since our sister hospital is the regional stroke hospital she should have gone there and not ended up under my watchful eye.

So when I had this patient I was definately thinking stroke - pt was COMPLETELY obtunded with a GCS of 4 - she only responded to pain and certainly couldn't obey commands. She was posturing. Every sign pointed to stroke. But she hadn't been diagnosed with having had a stroke.

The head CT that they did didn't show a stroke - a bleed anyways, which would have shown up on the head CT but if it was a thrombotic stroke, it sometimes takes up to 24 hours to show up.

Back to my story...
So GI came to the unit to see the patient, did quick questioning to the daughter who was there and of me and what I have observed while caring for her. So he decided almost immediately and said "ok, I'm going to take her to scope her in ten minutes if that's alright with you" - the daughter of course said yes... then not TWO minutes later did a porter come in the room saying that she was picking her up. I was completely shocked and thought that she was going to surgery. And when I made a comment in regards to that the porter indicated that she was taking her to CT.... which perplexed me because I hadn't heard this in report and hadn't seen a physician so I had no idea what was going on.

Of course I helped transfer her onto the stretcher then asked the porter to wait at the nursing station while I figured out where exactly she was to go to first. I headed straight to the charge nurse to find out what they knew about this all. Well turns out some physician had decided to order a stat head CT - but this patient also needed to have things figured out and needed to be scoped because she had certainly bled out of her mouth and I had provided extensive mouth care and didn't see a cut to the mouth to account for how it looked. But she also really needed this head CT. So it was decided that she would go to be scoped first then to CT and back to us.

Before the patient got back the neurologist showed up and questioned me about the patient. I indicated that I was a neurology nurse for five years and thought that she had suffered a stroke. But told him that it would be good for him to lay eyes on her himself and asked that I contact him. I asked if there was a way to get a hold of him in particular and he actually gave me his pager number. Surprising considering most physicians say to just call locating and contact him that way. Of course he's gone like 5 minutes and the patient returns. So away I went and paged him and he came so quickly!

Once he laid eyes eyes on her, he completely agreed and even said that he thought that it was possibly be a brain stem infarct because of the posturing - the oddity being the fact that her legs looked like this:


The patient had the first position, which is supposedly a indication of brainstem infarct. So he wanted a stat MRI because the head CT didn't show anything.

Of course while this is all going on I'm having to discharge one patient, deal with another patient who had massive wound issues and the wound care nurse needed me to go with her to do it. Plus another pt that I had to manage - who needed bladder scans q4hrs which of course meant doing In&Outs 3 times in my shift. Not included this is the regular duties - meds, bathing, etc...

So when this all went down I was up the crick without a paddle. Thank goodness for my buddy who offered to take a few things off my shoulders so that I could take a break and decompress a bit.

Crazy thing about all this..... MRI did NOT show an infarct anywhere in her brain, or brainstem for that matter. So nothing to account for her neurological status and clinical symptoms. But where I stand - I know that I did all I coud to keep her alive and well. Who knows if it stays that way, I hope it does, I know that it would destroy her family if that changes.

Friday, September 9, 2016

I'm in pain

So for the last two days I've been dealing with a pretty bad migraine. My meds don't seem to be helping either and so I've been struggling. It's hard to get stuff done when the pain is like this - when my head feels like it's being squeezed it's hard to concentrate on what I need to get done for school.

I have a "ways of knowing" paper, I'm about 3/4 of the ways done but my brain isn't really computing because the pain is so bad. I just feel like sleeping a whole lot - it's kinda how my body deals with pain. I tend to sleep quite a bit so that I'm not experiencing the pain.

I'm just thankful that little tyke started school again so that's been keeping her happy, if not a little bit more tired. Her first day you could tell that she was exhausted but by golly she would not go to bed any earlier than 9pm - come hell or high water! Surprisingly she made it to then and then completely crashed! I only wish every day was like that. Unfortunately, I know that won't last, give it another week and she'll be used to getting up early and the energy expenditure that occurs when you're at school with your friends. Bonus is that little tyke has said that she loves her teacher. Hopefully that means that she'll have a good month because with the move that means that she's switching schools and therefore will receive another teacher. So we'll see how well she copes.

With this migraine I really don't want to be staring at a computer screen any longer than absolutely necessary - so I guess it's nap time for me.

Monday, September 5, 2016

Trying my best

It's been a little over a week since I had my surgery. It has its good moments and bad - times when I think I may have an infection but then I'm unsure about what color discharge should be seen considering where the surgery was. I have follow-up on the surgery in a couple of weeks so we'll see.

I've been trying to not aggravate the area so I've pretty much been reclining or laying on the couch and getting my school work done. Boy I can't wait for this semester to be over, and it only just began last week!

Our prof has us doing our NCLEX prep stuff differently than what is normally done in which you study and then take the tests/quizzes. Well she has us doing the quizzes/tests without any studying so that we find out where we're weak and therefore need to spend our time studying THAT stuff. Her way makes sense, just wish she would have explained this at the very beginning. Oh well, c'est la vie!

I'm below where I need to be for the HESI but I know that I can get to where I need to by going through this process. I certainly know I have a bunch to relearn/remember from the paeds and OB course that were tested out of like 4 years ago!!! So it's not like the information is fresh in my mind or anything. I also suck at remembering cardiac stuff (Lt vs. Rt heart failure) or all the values for cardiac stuff (cardiac output, atrial pressures, etc...) or ventilatory settings - the norms and what you would do when they are off and such. I also suck at remember cranial nerves  - even tho that's where I worked for like 4 years!!! So bad!!! I also have to go back and remember developmental milestones & stages as well as immunization schedule (FYI they're different for Canada vs. the US!) so I guess I'm going to have study study and study some more. But at least I know where my sucky areas are.

This week and next week I have major papers due for the other course so I'm going to be busy plugging away at those. Nice this is that little tyke starts back up in school in 2 days time which means she'll be in a regular routine and I can stay awake all night long like I normally do without feeling bad that I have to sleep at some point during the day - at least while she's in school she's away and doesn't care that I'm sleeping.  Yay for little kids schooling!!!! Now back to studying....

Saturday, August 27, 2016

It's done

I had my surgery yesterday. I was quite nervous for it actually. I didn't know what would happen until I was under general anesthetic and could be examined that it would be decided upon.

We did the pre-op and it took FOUR HOURS!!!!  Goodness that was the longest pre-op process that I have ever been through. I would have expected that from the hospital in my hometown but not at this major city's hospital. It was ridiculous.

First I had to see a nurse and tell her what I was having done. Then she decided that I needed to have blood work and because of one of my IIH meds (diamox) I needed to have a ECG -> which showed that at one point I may have had a heart attack so then once I had those done I had to see a physician (after sitting around for somewhere like an hour and a half) and he kept asking me whether I have any chest pain or whether I can go up two flights of stairs without huffing and puffing. I indicated that I could and it seemed like they didn't quite believe it because they asked the questions just in a different manner. Plus I had to repeat all the same info I had told the nurse which I understand why they do it but I don't see why they don't just verify the information and ask if anything was missed or forgotten. He also asked about my IIH and I had to sign a release of information for them to get the neurologist's last progress note. So then I went and waited for another hour+ to see the next person.

Then I had to see an anethetist and repeat ALLLLLL the information all over again. And surprisingly enough they had the neurologist's note and so I had to discuss how I learned about that. Then I learned something new....
Succinylcholine (Sux) increases intracranial  pressure and should therefore indicate that it needs to be avoided. So I asked whether there was a chance that she would be my anethetist.... which she gafaughed and said "well there's 38 of us so it would be surprising if you do".... well guess what?!

I got the same anethetist!!! Rather shocking. Said that instead of Sux she would be using rocuronium (rock). She also had a teachling who said that once on the table she would give me some ativan - yay!

But HEEELLLLLLLL I woke up with a MASSIVE migraine!!!!!!!! Geeze my head hurt. But surprisingly my butt didn't! I was told that I received a fistulotomy. That it went smooth and exactly as planned. It was the first time in THREE years that my butt didn't hurt (well it was about 2/10 pain wise which for me is no pain really). I was sooo impressed that my butt wasn't the main bit that hurt.

Then I was given morphine on an empty stomach (bad idea!!!) and after I was out of PACU they wanted me to go pee which was harder than you think! They wouldn't let me go until I peed. However, I was extremely nauseous and just after I washed my hands I vomitted into the sink - OMG I couldn't believe it. I was so caught off guard, I couldn't even make it to the toilet 2 ft away!!! Thankfully when I exited the bathroom they had a basin that I could take with me back to my little corner and vomit along the way and lay down into my bed. Ugh I was so nauseous. So my nurse gave me a med to try to help me not vomit. But it didn't help. So I pretty much told my nurse that since I was out of options for meds to take to control the vomiting, I opted to be discharged so at least I could vomit in the privacy of my own home.

I came home, took a couple of my own meds (like zofran) so that I could feel better. Then went straight to bed and slept a whole whack load of hours. And when I woke up I wasn't nauseous OR in pain. It was glorious!!! Now for the healing part. I hope it goes accordingly so that I can go back to work and life and be able to exercise again!

Saturday, August 20, 2016

Getting ready

Next week is my surgery. On tuesday I have pre-op, then I'll learn what time I have surgery. I'm kinda nervous about it all. Going into this surgery I don't know what I'll come out of at the end of it. I'm sure hoping that this time next week I'll be over and done with.

And while I want to be optomistic, I've seen firsthand that that's not the way it always works out. I had a patient last year whose buttocks were a mine field of fistulas... I'm worried that I'm dipping my toes into a puddle I don't know the depth of which I'm getting into.

I'm just hopeful that I heal properly and that I don't have to worry about this issue any further.

And next week I also start the 'final' semester (good lord I sure hope that it's the final) - I'm getting a running start at it b/c the prof opened up the course already. It's going to be a doozy of a semester too. The other course is all about ATI, NCLEX and Kaplan - holy heck it's going to be a lot to keep my head above water. Plus I'm supposed to go back to work after I heal from this surgery.

Then we're supposed to move in the beginning of october. Hubby just asked me the other day what day I want to  move on. Problem is that I have a major paper & presentation due that week and so there's no way that it can be done that week - or it won't be a lot that I'm involved in. Good thing is that we're going to be in possession of both houses and so it doesn't really matter when exactly we move either than the fact that we're supposed to cut the utilities and internet here to move it to the new house. Unfortunately, I need the internet in order to submit my stuff so I don't know how we're going to work that.

Plus I'm sure that moving will add stress to my already stressfull life. Hopefully I can handle it all.

Tuesday, August 16, 2016

What is yet to come

I've moaned and groaned on here that a bigger house is needed.... been saying that for YEAAAAARS.

Now that I'm set to graduate and we can afford to actually move out of the hell hole, the in-laws have finally decided that they agree... no thanks to my BIL who is to be getting married in January and now that he wants a bigger area for his new bride, a brand new home is in order.

Move in date is October.

I graduate in December (God willing!) - and I just really want to move. But just in case that isn't the case, things will have to be done about this new house if we are to live with the inlaws still.

First off, there's only 4 bedrooms - the master bedroom is for my inlaws
then there's one room for my other BIL - the youngest one.
then another bedroom for my BIL who is getting married - he saw the house with my in-laws and I did not and supposedly he claimed this room..... I'll comment on this in a sec. It has a bathroom attached to it - sort of like a secondary masters bedroom.
Then the last bedroom is supposed to be for little tyke BUT

Hubby and I have been relegated to the basement (again!) and in this new house, the basement isn't finished - not even the studs! SO I said FORGET IT!!!! And I claimed the bedroom upstairs with the bathroom attached. I really don't give a crap about my BILs desires b/c this house was clearly bought with the intent for what HE needed, not what hubby, nor I or little tyke needed! 

PLUS - if I take the room upstairs, I'm certain that the basement will get done sooner! Plus I've made it clear that I don't want to live in the basement like I have to now. I know what I want done and until it is, I'm not moving out of that bedroom unless I get a nurse residency and then by golly, I'm gone!

So what must I have you ask?!
1. A full bathroom - beautiful shower, a nice vanity & sink, plus of course I toilet - BUT there must be a door leading to my bedroom AND one that everyone else could use (I don't want ppl going thru my bedroom to use the toilet).
2. Hard wood floors
3. Oh and while they're at it - put up the walls, cuz right now the basement doesn't even have the studs in!
4. At least one bedroom, two would be great.
5. A large window in the living room area since I actually like sunlight while I'm awake.
6. I would like a full fridge (right now I only have one of those small ones that kids take to college) and would like a hot plate and a microwave - so some cupboards would be good!

IMO I think I'm going to be upstairs for a long while. The unfortunate thing is that little tyke doesn't get a bedroom to herself until the basement gets done. I feel bad for her, but not enough that I would for go it all. 

Personally, I would rather just move away and get a residency. But we'll see what life and God has in store for me!

Saturday, August 13, 2016

Seeing it was amazing

So.... up next is another clinical experience....

The BIG case we had was a patient who was brought by ambulance as a stroke alert which means that CT tech is notified so that by the time that the patient arrives, they are at the hospital and the CT scanner is ready for the patient to be scanned. 

When the patient arrived, she could barely wiggle her left toes, had trouble lifting her left arm and sensation was drastically affected on her left side. Her pupil on the left side was sluggish as well. Her facial expressions were asymmetrical and she had a slight slur (ambulance personnel said that it was quite pronounced when then arrived) and grip was unequal bilaterally (less on left side). 

I immediately put her onto telemetry which showed A- fib (every other VS was within defined limits)– however the physician wasn’t concerned. I was baffled. I don’t understand why no one is ever concerned when they see this. I put in two large bore IVs (one in the AC and the other in the hand; on the same arm) and drew labs. 

Then she went to CT. It was clear which meant that she did not have a hemorrhagic stroke and if she had an ischemic stroke there was no evidence of that at this point. By the time that she had returned from CT her condition had changed, she was starting to be able to move her left side more freely. She was able to life her left arm almost entirely and slowly, but steadily she was able to raise/move her left leg & toes. Her left pupil was now reacting briskly. 

Upon return from the CT I did her EKG which still showed A-fib, however the physician struck this out and wrote out stable rhythm with occasional PVCs which I don’t agree with considering the A-fib was also showing on the strip rhythm. But as a student I don’t feel comfortable speaking up and disagreeing with a physician. I asked my preceptor about it and she said that she didn’t understand it but didn’t do anything further about it. 

We switched gears a bit to get the paperwork in order to give to the new hospital, give report but also still take care of our patient who thankfully every time we did another assessment was improving. By the time we transferred her to a stroke hospital, she was able to move all her limbs, her grips were strong and equal, her eyes were PERRLA, and expressions were symmetrical. 

I spent a lot of time with her and the family alleviating their fears and explaining things after the physician as well as answering many questions.  What I learned had to do with the last one. It was amazing to see a person with a stroke (a TIA is how the physician was classifying it given that her symptoms were dissolving right in front of our very eyes) and to see how the symptoms of it were evaporating slowly but surely, little by little. 

It was hard for me to reserve not telling this family that this event probably occurred because of her A-fib and that this physician simply ignoring this fact and not telling the family about it. I just wanted to yell it out loud!!!!!  Ugh so frustrating. 

I loved being there for this patient and for the family though through such a difficult time in their life. I could absolutely work in the ER and enjoy it for the rest of my life if I dealt with situations like this day in and day out!

It was also neat to see a stroke patient at that point and watch the symptoms disappear b/c coming from a neurology unit where we see the patients AFTER their symptoms have resolved or when their symptoms are more permanent. Frankly I thought it was awesome to see her symptoms resolve little by little. 

I think if I could do pediatric ER that would be awesome!!!! But we'll see how things pan out.