Sunday, November 30, 2014

Klebsiella pneumoniae - an interesting fact

Had a pt who has a UTI that has this growing in her urine.... that went in and infected her blood. Then because of this all she went septic and her liver and kidneys shut down....

Now the interesting thing is that this specific strain that the pt was infected with can ONLY be caught by FILIPINOs!!!!

Majorly weird.... even talked to infectious disease doc about it.... don't know how the pt even contracted the infection because they hadn't been to the philippines in years (yes their race was filipino in case you were curious).

Unfortunately, my pt spiked a temp tonight as I was leaving, also complaining of RUQ pain and then also had decreased sats (was 95% on my shift, no SOB at all) - the new nurse couldn't get the sat >90%,.. so off I go paging the on-call to get orders.... portable CXR and a change in antibiotics (still that the bacteria is sensitive to but in a different class).... so hopefully tomorrow we'll see a change for the better!

Friday, November 28, 2014

And I do my job so well

My last shift made me feel like I've mad a difference in a person's life for the legit first time.

I had a pt who needed an IV because of being on IV antibiotics and the doc wouldn't consent to an oral route. So I asked a colleague to help me out - they were a difficult stick and have had plenty of sticks so I figured I would get the best instead of rumagging around in their arms trying to find meself one! Well after break we managed to get a chance to get a go at it.... we both go in the room.... and JUST as she sticks my pt....


Now a few months back we were getting sooooo many fake alarms because of the ppl who designed the building and made the code blue buttons look like they could be call buttons..... so they put a shield over them to defer ppl from doing this..... now when they're pushed they're usually legit.

So our unit doesn't actually have our own code blue cart.... we have an AED.... BUT we ARE just down the road from one (we are next to cardiology and they have PLENTY of legit codes so it's only apt that they have their own!)...

Well it just so happens that where my pt's room is is riiiiiight across from where we store the cart (incl suction and oxygen tank in case the wall one doesn't work).... so because I wasn't being used in my own pt's room I went racing out and grabbed said stuff and raced to the room where the code was.

Upon entering the pt was in high fowlers so I immediately dropped the bed flat while a different colleague applied a non-rebreather... as we were getting this all done EVERYONE arrived.... the code team - the ICU team and of course all of my unit colleagues....

The ICU nurse handed over the CPR board.... while someone else applied leads on the pt and yet another went about hooking up the suction in the room....

The ICU nurse yells out "everyone stop we need to see if there's a pulse"

She subsequently checks for a femoral...

Nope, nothing.... "OK, start CPR"

Well my colleague, bless her heart, is vertically inclined and said that she would do CPR - ya I stepped on that one and told her ya right (oh ya, for some god unknown reason someone had put the bed HIIIIIIIIIIGH in the air) so there was NOOOOO way that she was getting to this guy's chest in order to start compressions! I told her to lower the bed and I would start CPR...

And goodness did I.... all that was going through my head was getting the rhythm right and the depth.... and immediately as I pushed down on this guy's chest did I hear (and feel) the "crack" of breaking ribs..... geeze it felt like I broke his damn sternum! And for the next 5-6 compressions I broke more ribs.... the thing that was going through my head at the time was "well if I'm breaking them then I'm doing something right!".... then time seemed to make me realize that I'm supposed to be counting for 60 compressions so that this guy could get some breaths!.... so off I go counting.

About 3/4 of the way there the RT decides that they're going to intubate and so off they go trying to put a tube in this guy..... and boy did they yank on his jaw and neck trying to get him intubated.... hell I could even see down his throat!!! But at least he was able to be intubated!

Then the lead doc decides that I had done CPR for long enough and declares that I need to change places.... so I stop.... and they check for his pulse....

SUCCESS!!!!!!!!!! A steady rhythm with a pretty good BP!

People seem to calm down and we wait a few minutes watching him and waiting to see if his heart will stop again.... and thankfully it didn't.

We got him stabilized and transported him to ICU where he started to come to and actually trying to move.... ALL a fabulous sign!

I can't wait to go back to work and find out what has happened since. It was all very thrilling to be a part of this and to actually be successful! To think that I actually DID something to bring LIFE back to someone! And trust me, you could see the INSTANT that life came back to his body. It was magnificent! THIS is the reason why I love nursing.... why I want to work in critical care.... to make such an astounding difference in someone's life.

Monday, November 17, 2014

Stupid administrators and good news

Got little tyke ready for school this morning and found a stupid lovely letter in her backpack that informed me that....

She has headlice!!!!!!!!!!!!!!!! WHHHHHHHHHHHAAAAAAAAAAAATTTTTTTTTTTT????!!!!

 Why the hell did I not get informed about this?! Immediately phoned hubby and yelled at him (he picked her up from school on Friday and did NOT check her bag).

The note said that she wasn't allowed at school until cleared by a family doc or by some head lice checking organization. Of course me indicating that she didn't have any (I checked her entire damn head and found NOTHING).

Soooo off I went to the walk-in clinic that my family doc runs... to find out that it was actually my doc doing it so I put myself on the list (I needed a refill of my pain meds and antiemetic).

I told him about my appt with the immunologist and the surgeon and so he forwarded information on to the immunologist about which testing we'd done already... so then when I see him in January he has a copy of the serology that we HAD done previously on my immunizations.

Then I had him check little tyke for lice and eggs and he found..... NOTHING - just like me!

Then I had to pay $20 for the damn note!!!! To prove what I already knew.

So when I dropped little tyke off at school, I indicated that she didn't have any lice but I still had to get a note for nothing and I thought it was ridiculous! Then they told me that the note didn't indicate that but just that it was found in other students.... ya, their note was completely obscure.... so I told them that they should reimburse me the money it cost me. They agreed that the letter was obscure and that they knew about it and were going to reword the letter. They told me that they had to look into whether they could reimburse me and said that they would get back to me.

Several hours later they actually called me and said that they would reimburse me!!! YAAAY

Tomorrow I have observation of little tyke at school so when I go and sign in at the office I'll get the chance to be reimbursed! Hopefully this causes them to reword the obscure letter and prevents other parents from experiencing this!

And now the good news.....

I found out today that I have a clinical placement!!!!!!!! FINALLY someone said yes! AND they've already selected a preceptor on my behalf! OOOooooo I can't wait now. I don't know any other details but I'm sure I will soon. I'm so relieved. Now I'll be set for the upcoming semester. The downside about this placement is that it's like 10+ hrs away from my current home - good news is is that it's only 4 hours from my hometown.... so when I go up for clinical I hope my mama will come to visit me. Wish me luck with this placement. I hope things will go well.

Tuesday, November 11, 2014

It's been confirmed, I'm not a hypochondriac

I went to the immunologist today.... good news is is that I'm not allergic to anything...

bad news - he agrees that "something" is up with my immune system - especially given my symptoms:

Hx of meningitis, recurrent abcesses
Inability of immunizations to stay active
Insomnia & excessive fatigue (I seriously have to sleep 10+ hrs to feel rested - and that's WITH meds to help me sleep!)
Joint pain - issues with my back, feet and knees

He asked if I had had any blood tests to check my immune system - I told him that when I had brought this up with my family doc I was told that he didn't want to - that he wanted to leave this up to the immunologist to decide. I would have been more ahead had I just insisted more - now I have to wait another 2 months (that's when I go back) to get some notions about what the hell is going on with my body. It's nice to know that I'm not crazy and that I'm not a hypochondriac (like my husband likes to believe! - he was a bit shocked when the immunologist agreed with me! It was awesome!!!!)

So I have testing to do - 11 tests in total - CBC, TSH, Immunoglobulins (G,M,A,E), ANF, ESR, C3, C4, CH50 - all baseline things that will give us an idea of what we're looking at or what further testing would need to be done.

Saturday, November 8, 2014

No more pokies for you

Tonite I had the pleasure of taking care of a lovely lady who made my shift almost enjoyable. Unfortunately I had the displeasure of poking her finger to check her blood sugar (though not a diabetic - with a stroke you can get high blood sugar readings and so we will often check their sugar for several days to ensure that the stroke hasn't affected the ability to control their glucose/insulin levels ) and it's been checked for long enough to know that her levels are JUST FINE....

so since she was such a peach about everything I figured that I would give back and talk to the MRP on her behalf and get her blood sugar checks discontinued....

which she was insanely appreciative about - hell she almost hugged me! Made for some great times!

THIS is one of the reasons why I love my job! Especially when it's something within my power to accomplish.

Tuesday, November 4, 2014

Killing me softly

For the last three weeks hubby's BFF, his wife and their two sons (almost 5 & 1 1/2 yr old) have been staying with us. All well and good except their sons have no semblance of boundaries and whine CONSTANTLY!!!!!!! If it's one thing I cannot stand it is that! I just wish that one or hell both of them would actually do a bit of parenting and step in to discipline them! Ok, I understand the whining from the youngest, hell he's a toddler, it's expected though it should still be nipped in the butt before it becomes a constant like his brother's! But alas, no such actions have been made. So ya, now I'm VERY happy that they've moved into their own house. So many times I just wanted to reach out and snatch the child, shake him and tell him to act like his age (the almost 5 yr old) or hell, spank his ass! Goodness knows the child needs some discipline! Several times the 5 yr old smacked his mother and other times would threaten to do so.... without them stepping in or stepping up - I unfortunately had to walk away and stay away in order to get through their stay.

On a separate note.... halloween just passed. Little tyke was sooooooooo excited. I had to work but I had everything put together so that it would be easy for hubby to take her out. He did so and she loved every second of it. She decided to be a fairy like last year - I think it was more because I got the movie Frozen themed winter boots and they went with last year's costume - plus she loves the wings. So I allowed her to wear the boots with the fairy costume and they went brilliantly together.

Work has been a bit interesting.... I had a woman in for a completely different issue and when I was in the room to talk to the roomate about her stroke and do some education, I overheard the woman mumbling to herself, not making much sense. I got called out of the room before I could investigate and when I came back she was sitting on the side of the bed with her IV tubing in her hand and the site leaking... because she had pulled it out. Her facial expression was blunted and almost appeared like she was drunk or drugged or soemthing. Weird considering she hadn't gotten any meds that would cause these symptoms. VS were within normal parameters. Blood sugar was a bit high but nothing that would explain what was being seen. So off I go to call the on-call doc - because this is happening at 2230hrs of course. Earlier in the evening I had to speak with on-call because the stool sample came back positive for c-diff. So she was familiar with whom I was referring to but told me that she couldn't come see the pt because she wasn't on site anymore. So she told me to call internal medicine on call so that's what I did. Nicely, they have their office around the corner from our unit so he said that he could come over and assess the situation. He checked out her labwork and there were a couple of values off (the day before when I had her her sodium was high so she was on 2/3&1/3 to try to bring it down) - now her sodium was down but so was her potassium (go figure!) and her magnesium was off and so was her phosphate.... so I got orders to try to fix some of the electrolyte stuff.... as well as stat CT of her head since she was no longer oriented or responding appropriately - she was also taking longer to respond..... the picture was just weird and didn't make much sense! At least I wasn't the only one thinking so! When I went in thte next day I found out that the CT came back with no new changes and no explanation as to why she was now confused and that things did not change when I went home or anything. We're hoping that once the c-diff clears up then her cognition will improve. Here's hoping!!!