Saturday, March 31, 2012

Trying to recover

I've been home for a day now and while it's nice to be home, it's exactly what I thought it would be like... where the family thinks that just because I'm no longer in the hospital, it equals not sick, thereby all better.

I will make it crystal clear that that is NOT how things are! I'm dizzy all the time, which in turn makes me nauseous. It really sucks, and knocks me on my butt when it happens. I get all diaphoretic and feel like I could just pass out and fall on my head.

Last week my MIL got hurt at work - something fell on her and it hurt her back and neck. Now, I'm not one to say that you aren't in pain since pain is subjective - we all deal with it in our own way. But today she had the nerve to tell me that because she manages to do things around the house and she's "sick", then by that logic, so should I be. WTH!!!! It's like comparing apples to oranges...

I honestly feel like I shouldn't be at home right now - I don't feel well. I feel like I'm going through withdrawls or something. I don't know if this is a SE of the prednisone since I've never been on it before but I know that I'm certainly not well enough to go back to work and therefore not well enough to do work around this house - not enough that anyone around here would take notice of anyways.

I really wish hubby had a job in his field so that we could move out - I'm absolutely fed up of the treatment that I receive living here. UGH!!!!

I need to get better quick so that I can go back to work so that I can save some money so that I can finish school faster and get a house of my own!!!!!!!!

Thursday, March 29, 2012

Discharge papers received

So by the power received by the doctor in my hospital, I have been told to go home... tomorrow that is. Dizziness in crazy intensity is occuring - new symptom for me... but Dr doesn't really care.

I'm being put on prednisone to hopefully help alleviate or cure the symptoms I'm experiencing. The Dr consulted the neurologist on what to do for me - I think I've stumped them with what's going on with me. Hell, I'm stumped so why shouldn't they be?!

I'm not exactly looking forward to going home - I don't quite feel ready for it. My body feels "off" and still not back to normal and therefore I don't feel ready to leave here. Especially to take care of little tyke.

I had my first shower in like 5 days, I know ewwww gross right.... well I assure you, if I could stand upright for longer than a bathroom pee break, I would be having one!!! Almost fell over today when I was heading back to my room I was sooooo dizzy. But hey, that doesn't seem to matter to anyone until I actually FALL. Ridiculous really. Felt good to have a shower, at least I look like a proper human being now, and I don't stink at least (not that I did before, thank goodness for the invention of anti perspirant and toothpaste!).

The ONLY thing I'm looking forward to is that I can see my family - my hubby and my baby girl. Even though my little tyke is a handful (being almost 3 will do that!), I miss her dearly and love her to bits and pieces. Hubby seems to have actually missed my absence. Tho I suppose when the caregiver of the little one leaves, that makes more responsibility for him right?! So I don't really blame him for missing me :P Even tho I say that, I know that he misses me because he loves me - as I love him. He's my rock... just wish he would have spent more time with me while I've been in hospital - I've been really lonely considering he's spent VERY little time being with me. A couple of dinners here and there is about all. It hurts my feelings but what can I do? And I know that one might say that he has the responsibility of taking care of little tyke... well considering we live with his family, that's not necessarily a requirement since he can ask them to watch her while he comes to me. He has brought her with him a couple of times - I know that little tyke certainly misses me. When she's seen me, I still had the IV and so she was quite apprehensive about touching me cause I had a "boo boo".... VERY sweet and VERY innocent.

I also miss my own bed - tho I do like the electric aspect to the hospital bed - quite convenient at times!!! Certainly makes one more lazy when getting out of bed!

Long story short - I leave tomorrow AM, I'll know more about follow up then. I know that the Dr is giving me at least til Tuesday to recuperate and should I need more time then I have to see my family Dr. I guess that will have to do, it's not like they're giving me another choice in the matter!

I need to be fixed

Well I'm still in the hospital.... it's been 6 days now, and still no end in sight. I've been attached to an IV for 3 days now, KCL 20mmol NS @100mL/hr, being that my potassium was low (probably because they put so much NS through me - like 3000mL), and they wanted to give me as much fluid as possible.

As I mentioned in my previous post - the belief was that it was either meningitis or encephalitis. Well it turns out that it's neither. At least that's according to my LP, CT and subequent MRI. All of them turned out to be normal. Well technically my LP had a cell count of 4 but anything below 6 is normal. So who knows.

The neurologist believes that I have a viral migraine - that I had a virus that "bugged" my brain and the migraine was the end result. Or that I had meningitis but since I took so long to go to the hospital and see someone and find out what was wrong. The problem is is that it doesn't want to go away. It's pretty bad that I can't be upright any longer than a bathroom break without the migraine hitting me like a sack of bricks. Holy shit does it hurt!

Also, the MRP (most responsible physician) for me took the morphine away 2 days ago - she believed that I was possibly getting a rebound headache from the morphine. So pain was to be my constant companion. At least I had Toradol - until the next MRP took THAT away, with the belief that it wasn't helping so why take it. Ya, nice thought UNTIL I experienced the migraine without it... normally when I'm laying flat I can manage the migraine... well without the Toradol, it was like I was sitting or standing upright. The pain SUCKED!!!! I still don't have the Toradol, but I'm being given Motrin - it only JUST barely takes the edge off. Not really though, but trying the positive thinking.

This morning a new symptom - dizziness.... while laying flat!!! And it wasn't like I was turning my head, getting up, or doing anything AT ALL... I was laying down doing NOTHING!!!

So now I have no idea what's causing this. It sucks! I miss being at home with my family, I miss my husband and my daughter... and I know that they miss me as well.

About the dizziness, the MRP asked to have my VS taken again - they haven't changed from my original set this AM so it's not like it's from HTN or hyptension. I don't know what could have happened to cause this symptom but it's not going away - at least not yet. The MRP still hasn't come to see me since the original visit, maybe she's looking into talking to the neurologist to find out what COULD be causing it.

I guess time will tell. Hopefully I get off the IV - I've heard that my potassium is back to normal and the fluids don't seem to be improving my migraine situation. Guess we'll see about that as well.

Sunday, March 25, 2012

eenie meenie minie moe

So I ended up at the hospital afterall... turns out I have the symptoms associated with meningitis or encephalitis - but which one is it... hence the title.

By the time I was fed up with meds not helping my pain, I hightailed it to the hospital. Though by then my fever had broke, or was in the process of breaking thanks to tylenol and motrin being used interchangably throughout the day, when I was FINALLY triaged it was 37.8. So when I finally saw a Dr, this is what occured.

First I had blood work done and my urine sample taken. They wanted to see if I had a chest infection or something else.

Then I had a chest x-ray done, that was clear.

Had a head CT done, that was clear.

Blood work and urine sample came back clear.

Lastly I had a lumbar puncture (PAINFUL btw, helped take my mind off the migraine - thankfully I had just received some morphine before the LP so it wasn't quite as bad but DEFINATELY hurt!).... but even THAT came back clear.

So ya, Dr doesn't know what's going on with me. My symptoms are consistent with the two - I did have a high fever before, that's now gone but the migraine and positional issues still remain. As do nausea and vomitting as well as photophobia.

I'm out of the hospital for the moment - was in since thurs evening. Pretty much the Dr wants me to go to my workplace now and be admitted there because the other hospital in my city doesn't have an MRI machine and neurologists only work at the sister hospital and there's a waitlist to see them. At least if I go to my hospital, there's both there at hand.

I'm on SR morphine - not really helping - trying to remain as supine as possible. Pretty sure I'm heading to my hospital in the AM. I would go now but I just want to sleep in my OWN bed, just once. Unless this migraine goes away tonight, tho that's highly unlikely since it's lasted for 6 days now.... sooooo frustrating.

Hopefully one of the neurologists at my hospital can actually help. Here's hoping anyways!!!

Thursday, March 22, 2012

Meningitis (in the back of my head) or just a migraine?

The last couple of days have been difficult to get through. I went to the Dr's yesterday to get a sick note as I called in sick last week - still not 100% but enough to go back. I'm fighting a throat infection thingy, with a bit of a cough and I feel it's going into my left ear - when the Dr looked in my ear, she said it was clear. She did, however, say that my throat was reddened.

So I went to work yesterday and developed a headache while at work - took some Motrin around 1900 hrs and went on my merry way - working/fighting through the pain. The Motrin didn't get rid of the headache but at least took the edge off so that I could still focus on what I needed to do. Being in the DRY DRY hospital didn't help my throat either, was coughing quite a bit, think it might have irritated it more and also could have increased my ICP, not helping the headache situation.

By the time I came home the headache was starting to increase again, so I took some more Motrin and my other nightime pills and climbed into bed (approx. 0030 hrs). When I woke up, HOLY BATMAN was my head killing me! I felt sick, sick, sick. I took some motrin and stayed in my bed, figuring that I just needed some more rest or something. But a couple of hours later I felt like I was febrile. Checked my temp, and sure enough I'm sitting at 40.1 C - remember that I had already taken Motrin... So I take some tylenol headache - which has ES tylenol AND caffeine... should have helped my fever AND my headache BUT IT DIDN'T help ONE BIT! Didn't even really touch the pain.

Two hours later I couldn't take the pain anymore so I went back to the Dr. She checked my temp - yep still had a 38.0 temp. Because I'm allergic to codeine, demerol, and percocet, there wasn't a whole lot she could wanted to do about giving me something to relieve the pain... but she gave me a migraine medication.

When I went to pick up this med - for EIGHT doses, it cost me $147.47!!!!!!!!!!!!!!! HOLY EXPENSIVE! I almost crapped my pants! But honestly, I would have paid anything to make the headache go away.

The first dose didn't do a thing for the pain, two hours later I took the second dose (and now I can't have anymore for 24 hrs!) and it took another 3 hours for ANY pain relief. On a scale of 1-10, I'd put it at a 6ish... but the pain gets worse when I sit up or stand up. SUCKY! Which on that scale is like an 11 when higher than a supine position.

I hope I get better quick cuz I don't want to have to go to the hospital, I am at one enough because of my job, I know how things roll there and things take FOREVER to get done!!!!

Saturday, March 17, 2012

Febrile children Oh NO!

Went to bed last night and checked on the kids before getting in myself - to find out that my eldest - kiddo had a temp. I KNEW he did, just by touching him. When I finally found a thermometer (don't know where they all went, we own like 8 of them!) and checked his temp, it was 102.9 F (39.1 C) - poor kid felt like crud. Said he had a headache and his legs were hurting and he just felt crummy. Gave him some tylenol and tucked him back into bed.

Gave him tylenol and tucked him in for the night. Thankfully in the AM it was normal again. I was also thankfully that he wasn't feeling nauseous since he has a SUPER finicky/sensitive stomach and vomits VERY easily.

When he was young, I couldn't force him to eat because if I did he would vomit it all up and then I would be further away from my goal than I would have been if I had let him stop eating when he wanted to.

I also know that when kiddo says "mom, I don't feel so good" I need to find him a container to vomit in IMMEDIATELY or else it's going all over me or right in front of him, and that could mean on the floor or all over the car! Such was the last time I did drop off for visitation.

He has hockey tomorrow, hope he's feeling all together better. I hate seeing the kids sick.

Friday, March 16, 2012

Steven Johnson Syndrome

I don't know about those who read the blog, but this is something that I have seen several times. When I first learned about it, I thought it was a rare occurance. However, we have someone on our unit who I SWEAR has it! Not that he's been diagnosed with it - doctors just think of it as a toxicity to one of the meds that he WAS on. That being said, when I started to peruse the internet about it, I learned that it IS indeed a side effect of one of the medications the pt was on.... dilantin. Prior to my perusing, I was under the impression that those who experience this VERY PAINFUL condition, that it's mainly due to a reaction to antibiotics or NSAIDs.

When I found this I had an "a ha" moment. I honestly don't think that the doctors on our unit managed this pt's condition well because he wasn't diagnosed with this.

This is the sort of things that the pt was experiencing....

Now his appearance wasn't as severe as the flank picture, and his oral mucosa wasn't this severe - but you can see how bad it can actually get. It can LITERALLY affect EVERY part of your body - and it's just like a SUPER SEVERE sunburn, and therefore you see blisters, weeping skin, peeling, etc. And they treat this condition as they would burns - preserving the airway because sloughing can occur in/on ANY part of the GI system - from the mouth to the anus, and the respiratory system as swelling can occur and these two things can compromise the airway. It's something that should be monitored closely.

Our poor patient blew up like a balloon, he was soooo sick. And because of restraints, blisters tended to form right under those and were so painful for him. Unfortunately he needed the restraints so you often felt bad having to go into his room to do personal care because you would have to fiddle with the restraints and turn him from side to side. VERY painful.

So be cognizant of seeing something like this and that it can become WAAAAY worse in a VERY short period of time. I wish that I was around when our guy was acutely ill because I think that he would have gotten the care he deserved. But I think that if the doctors had never seen anyone diagnosed with it previously, it's hard to connect the dots and come up with the correct diagnosis and therefore the correct treatment. I just wanted to share this so that anyone who reads this blog, will know that this is possible. My patient had this occur because he was on Dilantin - for seizures, but the docs didn't recognize his symptoms as SJS but treated it like it was an adverse effect - ya it SURE was but they certainly didn't treat it as SJS. Poor guy either way.

Monday, March 5, 2012

Manager's should leave well enough alone!

I'm an RPN (LVN/LPN for those US ppl) and at my hospital we get to practice to FULL scope - which means that we can do ANYTHING an RN can, minus take care of unstable patients.

So on one of my evening shifts I had the privlege of carrying 5 pt's - one where the family is over bearing and there looks like there's going to be legal action taken against the hospital as the family feels that the hospital has caused their mother's stroke (for another post); one pt that is a total care, but she turns really well, and she's a diabetic which means glucose testing and insulin; another pt is independent and only requires 1800 meds. Then I was supposed to get TWO admissions! Now one is enough but two REALLY sucks! And this I knew was going to be the case as soon as I started my shift. CRAP, CRAP, CRAP!!! At least that's what I said in my head.

The ONLY saving grace was that one of the new grad RPN's was going to be shadowing me for 4 hrs. GREAT! And good thing I had her or else I would have been screwed!!! Before the newest patient came up, I took report on the second patient. This is the report for patient number one...

Female in with confusion NYD (not yet diagnosed) and diarrhea. But she was in FOUR POINT RESTRAINT!!! Ok flag number one! Ok, on with report.... aggressive with staff and that's why she has the restraints on. She's on 40% oxygen by mask.... flag number two!! Then I get given her VS - temp normal, pulse in the 90's (okies... sorta), BP normal, O2 of 96% on said oxygen.... but flag number three and probably most worrisome was that her respirations were 40!!!! Yeah this doesn't sound normal... I was told that pt was stable and that there was a referral for a Dr - one that I've mentioned before I had to call in the middle of the night (refer back to my post about my pt with seizures and a back compression fracture). Another issue I had while I took report was that this pt was a diabetic, NPO but only on NS (normal saline) TKVO (to keep vein open)... which didn't make ANY sense because you would think that critically thinking that this pt would become dehydrated since she had diarrhea, was NPO and was a diabetic... ok whatever, I'll bring it up with our MRP (most responsible physician) who would be responsible for this pt - and get her started on D5W at 50cc/hr or something like that. At least that way you are addressing the dehydration possibility AND the diabetic sugar levels.

WELL, when this lady came to our unit, she looked and more importantly SOUNDED terrible!!! I don't know if any of you have ever heard of the "death rattle"... the sound that the chest makes when a person is close to death and aren't swallowing their saliva and these secretions go into the chest and make it sound all congested.... well that's what this lady sounded like. It was crazy - and all of us nurses were like, "why is this patient even coming to our unit, she should be going to ICU"....

The porter, RPN shadow girl and I transferred this patient onto our unit bed and away we went with our assessments. I had the other RPN take the respirations and I would get her BP, pulse and O2 sats.... Again BP was fine, pulse was elevated and O2 sat was 80%!!!!!!!!!!!!! And that was on 40% Oxygen - 8L per minute... MRP was on the unit and I went and grabbed her and had our unit clerk page support (part of our code blue team - which in essense is like me calling a silent code blue) - put the patient in high fowlers and went to grab ventolin and atrovent as well as suctioning equipment. RPN gave us a 40 resp rate and I gave her the suctioning equipment while I set up the breathing treatment. While she was on 100% O2 - during the breathing treatment - her level stayed above 92% - but once we put her back on the 40% she would bounce between 67%-94% sats... the 67% happened often because she was also having periods of apnea and would only breath once you verbally stimulated her.

Once she was stabilized a bit - where she was sitting above 80% sats for more than 5 minutes - I spoke with my UL (unit leader) about what this patient looked like clinically. She asked me whether I wanted someone else to take over. I told her no - that although she was unstable, she was stably unstable and that I felt that I was supported by many people on the unit. I had the MRP there, that if things changed that I have SEVERAL RN's on the unit that could take over, and that support was already paged and I knew what threshold to initiate calling a code. I also indicated that since I had the other RPN, I could stay with this stable patient in a closer fashion than is normal, for our unit.

Therefore I kept this patient... Thankfully I had the other nurse, who then took the initiative to take the blood sugars on the other people, as well as this new pt... and give meds, while I was caring for this new patient pretty much on a 1:1 basis.

About an hour later support came and assessed the patient and then got the other referring doctor to come see the patient and made the decision to put this patient in the ICU - all the while we are ALL in agreement that this patient should NEVER have come to our unit! The support nurse thankfully found a spot in the ICU and put that stuff all in place - without having to go through many hoops that would generally have had to occur and instead it was going to be a trade off. When this patient went to ICU, that I in turn would get an ICU patient back to me (one that was ready to be D/C'd from ICU though). By the time that that happened, I had this patient for almost 3 hours... it was craziness!!!! My lady patient was so unstable that we sent her, not by stretcher, by left her in our bed and wheeled her down the hallway to ICU. With me in tow, ensuring that she breathed.

It was funny bringing her to the ICU because when I gave the nurse taking over, report, she asked me if I would ever consider working in ICU... when I told her yes, she told me to apply for a job. I had to tell her I had to wait another year and a half until I finish my RN, and then maybe I would. I think that this shocked her. LOL

Thankfully I didn't end up getting ICU guy, even though I took report, because I was told that he was quite a handful (had him my next shift and yes he was!!!). Just as I transferred my lady to the ICU, I got my second admit, who although not unstable, was still pretty sick. She was septic and the poor lady had chronic liver cirrhosis and her belly was BIGGER than a lady at 9 mos pregnant - and anyone who reads this and has been to that point - you can totally empathize with her.... sooooooo uncomfortable!!! And her poor legs looked like tree trunks they were sooooo edematous.

Much to my surprise, half way through my shift, when my RPN pal went home, another nurse on my unit helped me by unloading one of my patients - which was UNBELIEVABLY helpful!!! When she did that, she lightened up my load tremendously and allowed me to focus on the unstable patient, but still touch base with my other patients since they were all in the same area and the patient she took was in a TOTALLY different part of unit. Bless her heart!!!

Such a crazy shift! Hope I don't have one of those for a long, long, long time to come! I guess it serves me right since I've had such quiet, easy going shifts before this... I just had a feeling that it was the calm before the storm, and WHAT a storm it was! But I guess it made for a fast and interesting shift and an interesting story for here.

Also - this is being investigated because if the nurse had done her assessments thoroughly, she would have noticed the respiratory distress, should have realized that this patient was NOT suitable for my medical unit, and SHOULD have contacted the physician to indicate this. ALSO, IF the manager of the ER hadn't gotten involved and MADE the nurse call my unit to send this patient to MY unit, the patient could have been given enough time to be assessed by the referred doctor and wouldn't have been sent to my unit in the first place (IMO!). Interesting all the way around!