Saturday, September 20, 2014

My placement rocks!

Finally got a moment to post about placement. The hospital is ginormous! I couldn't believe how big it is. My hospital is BIG.... this one trumps it almost three fold! It's amazing. I found out it's about 15 years old, so it terms of newness, it's pretty new (IMO).

I saw some pretty cool things. Didn't do much myself until the last day there. I put in three foley catheters and discontinued one as well as an IV. Nothing spectacular but at least I can check it off my clinical skills checklist. Oh and I did a TON of EKGs so now I feel pretty confident about doing them myself. At my hospital we have a tech that does them all. I was thrown into the lions den with those the very first day.

Day one was pretty awesome, there was like 5 traumas in like a 4hr period of time. The first one was the best. Maybe I'll write about it another time. HIPPA might come back to bite me in the ass because it's an interesting case so I need to figure out ways to change details to get around it. I did get  involved on a little one who was dropped and suffered bilateral skull fractures..... the poor little one cried the ENTIRE time... I mean, I would too.... I'm pretty sure he/she was experiencing a pretty terrible headache.

Another person we sort of dropped into our lap. We were floating in the unit and were doing something to help another person when my preceptor Anna noticed that a fellow nurse was running towards CT with a patient and knew that something bad was going down. So she called for me and off we went running to help. Well it turns out that their pt was having a seizure when the chief complaint they cam in with was COMPLETLY different.... as in they were classified as a NSTEMI and when they were questioned further told the nurse & Dr that they also had a headache with hypertension and so the doc wanted to clear this person's head..... just in case it was something else!

Well good thing they were already on their way there.... too bad this pt wasn't protecting their airway very well. Completely non responsive. Got an emergent CT scan and the oxygen level remained high enough that an emergent intubation wasn't required at that point. We were able to get the scan and found the pt had a subdural /ventricular bleed... neurology was pretty sure it was an aneurysm that burst. While they were trying to get a scan with gallium for a more definitive determination, the pt started to come back neurologically and respond to pain and shortly after that to voice. We then moved him/her to trauma bay "just in case".... good thinking!

Neurology decided that they wanted him/her to be put on a cardene drip to control the BP to be <140 systolically... well for those who don't know, you have to wait 15 min after starting to know what the response will be on the BP. Well the BP dropped from a SBP of 150ish to 103.... not a good thing so we paused it. And for the next 15 minutes, we hung out in the trauma bay while different hospital services came and did their assessments. We let the spouse come in and sit and chat during this time. The doc also came in and talked to both of them to find out what their wishes were for treatment and such.... good thing, especially considering what was to come!

The pt was complaining about how their chest and their head was killing them... I asked a couple of people for orders for a pain med. It's not fair to the pt to stay in pain (IMO) but I wanted something that wouldn't strew neuro findings (as a narcotic may). Because the pt had soiled themselves during the previous seizure, we also took the time to cleam them up. And we also put a foley catheter in because we knew that the pt was sick and would need close monitoring.

After we were done, the pt asked if they could sit up some so we put them at a 60 degree angle from about a 15 degree and didn't do so quickly, but simple took our time. Then not even 2 minutes later the pt started SCREAMING about how their head hurt and that it was "stabbing" so my preceptor went out of the trauma bay and I dropped the head back flat because I figured that THAT was why there was a change.... then the pt stopped responding and had a tonic seizure right in front of me while I was trying to do a neuro assessment. Lost consciiousness and was super rigid. Before this happened, I had given her a mouth swab to wet the mouth and tongue since we wanted the pt NPO (nothing by mouth).... mouth swabs were cleared by the doc though provided they didn't swallow. So when the seizure happened they clamped down on it and I had to pry it out of the mouth. Then I ran to the door and yelled that the pt was having another seizure.

Then a code was called so that the necessary people come running and I swear, 20 ppl arrived in like a minute! It was quite impressive. One of the residents that was involved in this case during the original seizure came to the head to try to protect the airway. I was at the head of the bed and was responsible for monitor. I did another BP and it was now 198/130 (I know the top number but I kinda forget the bottom one.... though most often we generally care only about the top one anyways).... so that was quite shocking. We turned the cardene drip back on, this time higher than it was originally while the docs got situated. During this early phase the spouse was still in the room (OMG right!) and I made contact with them to try to let them know it was going to be alright and that we had things covered. At some point the spiritual care person took the spouse out of the room and comforted them.

In the meantime the pt's heart was going crazy and doing all different (very bad things) such as torsades which then progressed to 2nd degree heart block (FYI this one can lead to cardiac arrest) so out comes the code cart... all while other people are pulling up meds to intubate. THANKFULLY her own heart cardioverted back to a normal rhythm (probably because of the cardene drip) so we could focus on intubating... which went without incident.

Then things calmed down a bit and a lot of the people left the room, and we proceeded BACK to CT to get another scan.... which showed a progression (we kinda figured that though). And then we brought th pt back to trauma and by then neurosurgery made their decision about what they were going to do.... they were going to do a "bolt".... which means that they were going to do a ventriculostomy - drill into the pt's brain to stick a tube in to drain some of the fluid off the brain while measuring the intracranial pressure (ICP). I stayed pretty darn close since I'd never seen it before.

Unfortunately the pt was a fighter of the propofol and started to move when neurosurgery was making meaurments so I was asked to go under the sterile field to hold the head in the correct plane. Well it's a good thing that I kept my hands there because there were several times where the propofol amount wasn't enough and required more.... in a one hour period of time the pt recieved 400mg!!! As well as Versed.... so it was shocking that this person kept trying to move. We also put restraints on - just in case.... good thing for that because I'm sure that the pt would have pulled the ET tube out or at least broken the sterile field.... bad things either way!

It took a bit for the bolt to go through the dura but once it did you could immediately tell the pressure in the pt's brain was extreme because the fluid came out immeasurably though once the bolt was in a tube was threaded through and then hooked up to a measuring device that was based on gravity to draw the fluid out. Immediately 18cc was taken off which is a SUPER high amount. But you could tell that the fluid that was draining wasn't just blood but cerebrospinal fluid AND blood mixed. The closest comparison I can explain it to is serosanguinous fluid.

We eventually got the pt stabilized enough to take to ICU. Boy was the entire thing from start to finish crazy though! I must say, I can't wait to go back!

Tuesday, September 9, 2014


Had work over the weekend. It sucked. Had to take care of a person who came as a direct admit from another hospital's ER to our unit that really should have gone to the stepdown ICU - as in RR of 34 with nasal flaring and major abdominal and shoulder breathing (just shy of sternal indrawing) so ya, pretty serious! ABG's came back as respiratory acidosis, however, person was DNR (including no intubation - YAAYYY finally!) but even said "If I knew dying would be this difficult I would have signed up for something different!" WHAT DO YOU SAY TO THAT?!!! I mean, they're 85 years old - so it's not like they haven't lived a good long life!

I tried to get ahold of family - called the contact number and left a message. Got a different phone number for a different family member - tried that one and was told it was the wrong number/person - and the other person was in another country several hundred miles away by plane and didn't want us to call them. We have to abide by their choices.

Next day, come in to find out that I would be now transferring this person to where they should have gone in the first place. Family has shown up. On the way to the SIMCU we talk about what would happen once we arrive - that the person would be put onto bipap since ma/pa decided to be a DNR - they didn't take that information well - they were shocked that this person would choose this without consulting the family! How incredulous of them! I explained that this was decided at several different points along the way - before any extreme fatigue and hypoxic confusion set in - spoken about to SEVERAL different HC professionals. That I (as well) spoke to ma/pa about this and was confirmed that no heroic attempts be made to save their life. What the family was so upset about was that one of the children was in another country and should this person die, that this would be a very bad thing and that THIS part should have been discussed first so that this person would be given the opportunity to make it should things turn south. 

THAT part I could understand. But again, I had to stress to the family that the ultimate choice was still up to ma/pa and that all they could (we included) do was speak to ma/pa about their decision and maybe postponing it a bit until said family member could arrive at bedside since they were doing so poorly and required such measure as the bipap to be able to continue breathing.

Situations like this make me wish that I was finished my BSN and could follow this story. The little ol ma/pa was a sweet ol soul who I enjoyed taking care of. They had a bit of a spit fire about them. I hope that should they decide to maintain the DNR that the suffering is minimized. I think dying from a respiratory issue is a terrible thing since you are so acutely aware of air hunger when unable to breathe anymore. ya never know, ma/pa could pull a miracle out of a hat and turn a corner - crazier things have happened!

On an entirely separate note - almost started bawling this evening.... saw that Kate Middleton is pregnant with baby #2 - yay for them but boy does it make me feel blue (and green).... one of the girls is pregnant at work, I was happy for her.... then I found out one of my pals is also pregnant (was told just this past weekend)..... I'm really jealous (I'd say envious but I think I'm past that point). I WANT A BABY!!!! I WANT IT TO BE MEEEEEEE!!!! I know that when hubby decided no babies for us that I was crushed, but I figured that I could get over it. I'm not so sure. I want what everyone else is having but me. I know getting my BSN takes precidence but how do you balance the needs and the wants?! So ya, I was gutted by the news of everyone else getting the chance to be pregnant and have babies and I don't. It sucks and I just want to crawl under my blankies and wallow in self pity. Maybe I just will.

Saturday, September 6, 2014

I don't share stuff very often

Facebook is a place where I procrastinate on and the other day was no exception....

And what I found was all kinds of awesomeness!!!

Hopefully this link works....

I like the song and what they did DURING the song is spectacular!!!

What do you ppl think?

Thursday, September 4, 2014

Summer trip was fun - now back to the grind - ***It's going to be a long post

I'm coming up to the end of my holidays. It was nice while it lasted. Going home to see family and friends recharged my batteries. I don't feel absolutely overwhelmed for this semester at least. For the summer one I certainly did, hence why I had to drop one of my summer courses. We're finding that the first month and a half is insane with due dates and such. I figure that they do this to overwhelm as many people as possible to have those who can't cope end up dropping the course.

I'm doing my core nursing course - nursing care of the adult II - and I get to do it at a level one trauma center. They have six helicopters at their disposal so ya, I'm excited to say the least. I finally got a hold of my preceptor (lets call her Anna, cuz I'm sure I'll talk about her again and it will make it easier - as you guessed it, not her real name!) with whom I was emailing back and forth with but needed to speak with over the phone. Unfortunately, I was having difficulty arranging this because I was on vacation and she was working a LOT - likee 52 hours a week or more! I left messages and she FINALLY answered just the other day. I was starting to get UBER nervous/anxious that I would have to ask for a different preceptor because I couldn't get in touch with her and there were forms that needed going over in order to be able to be granted permission to start my hours by my faculty.

When I finally did get a hold of Anna we talked for two hours first and my cell phone provider cut me off indicating that I had talked long enough and their policy indicates that at that point, they cut the call off. Thankfully she was a good sport about it when I called back. Then we talked about another 40 minutes!

We talked about the unit and what sort of things are seen, what I should expect as well as a little bit of homework - mainly meds that are used a bunch that I'm not familiar with. We talked about goals - Anna wants me to give CPR during a code a go and for me to learn to read ECGs and know what ones are important. On my unit we have the capability for tele but don't use it, for whatever reason. We did talk about the different things I am familiar with, being that I work in a hospital.

The only thing that's upsetting about this semester is that I don't get to do it with my friend. We became friends being that we were in the same beginning/graduation class and frequently interacted with each other and it just lead from there. A couple of months ago she told me that she started bleeding - she's post menopausal - so this abnormal. She indicated that she had a history of fibroids so I figured it was something like that. I was wrong. While on vacation she texted me to tell me that she was diagnosed with cancer, so of course I called her immediately - straight to voicemail (ARGH!), which I left one of course. Once at the hotel I called her again and got a hold of her. Thankfully she was only stage one (possibly two) but would need surgery ASAP to remove her uterus but that depending on test results may require radiation (but probably not chemo). Unfortunately, she would be out of commission for over two months recovering and such (if not more if she had to have radiation) and so she had to bow out for this semester. I'm so thankful that this was caught early but it's so crappy that she has to miss out on a semester because of it. She's come through a lot of things to even get to this point (hell, know the feeling!) so I know she can get through this - she's a strong, strong woman!

Another crappy bit was that we had arranged for our clinical to be at the same hospital and so we were going to share the cost of accomodations and such. Now I have to do this all by myself. A new city, new hospital and everything that goes along with these things. Such a bummers. I went into this thinking I would have a good friend to debrief about my experience with (maintaining HIPPA of course) and now I won't.... til next semester anyways. Plus this means that we probably won't graduate together which makes me really sad.

Speaking of school, while on vacation we stopped at the university and met my current prof, tried to brown nose a bit. We also bought some uni parphenalia as well as a pocket guide (extremely useful for this course - and the next course - which I found out should be critical care based) so this should be perfect. I got this pink hoodie that is really sweet and I can't wait to show it off. It will replace my current one that my MIL hates. I also got a coffee mug, T-shirt and a half zipper sweater (that I like the color of but not really the decals or the half zipper aspect - IMO it should either be a hoodie or a full zipper).

The trip was tons of fun - well except that around St. Louis there was new freeways that my GPS didn't know about (nor did it recognize the address of my hotel) - and hubby yelled at me because I listened to the GPS directions and not to his (he was the navigator - but it's not like he had a map that he was telling me directions off of) and so we had a huge blow out on the side of the highway until we figured our shit out and carried on our merry little way (an hour late we arrived at our hotel but whatever, it's not like we were in a hurry!).

We missed a couple of the BBQ places we wanted to go to, which was incredibly disappointing. But we made do and found some yummy foods. We went to the St. Louis zoo which was a LOT of fun, I highly recommend it! The only thing there that disappointed me was that the giraffes were penned into the barn area so you could see them closely, but couldn't touch them, whereas if they were allowed to go to their habitat area then you could potentially touch them (was really hoping I could!) - instead I had to be ok with just seeing them through bars. Another really cool part was that they had a ton of elephants (a bunch of baby ones too that were really cute) that were fun to watch. Lastly, a lot of their animals you could get really close to because they put glass close to the animals - case in point - the gorillas were a disgusting hoot - there was a husband and wife (the female was grooming the male so I figure that they were attached) that we checked out and watched for a bit and boy were we entertained!

First the female picked her nose (ok, ewwww), looked at it and then ATE IT!!!!!!!!!  ARGH!!!! Then two minutes later she vomitted INTO HER HAND (gross again) then ATE IT!!!!!!  OMG yucky! Then she went back to grooming her mate and eating whatever she found. Her mate had a wound on his shoulder and she stuck her finger into it and AGAIN proceeded to EAT IT!!! I couldn't believe it was happening. Again she went back to grooming her mate when all of a sudden he turned around and SCREAMED at her (I think she was a bit stunned), then he turned around and let her go back to what she was doing. So we moved on. Boy the memories tho!!! HAHAHAHA

It was a great trip - hopefully I can get the photos uploaded onto the computer and actually put some up. We'll see how busy keeps me!