Creutzfeldt-Jakob Disease (CJD)

We had someone who was suspected of having this disease - my knowledge isn't the best but I knew that it could be transmitted to others.... here's what the NIH says....

There are three major categories of CJD:

• In sporadic CJD, the disease appears even though the person has no known risk factors for the disease. This is by far the most common type of CJD and accounts for at least 85 percent of cases.
• In hereditary CJD, the person has a family history of the disease and/or tests positive for a genetic mutation associated with CJD. About 5 to 10 percent of cases of CJD in the United States are hereditary.
• In acquired CJD, the disease is transmitted by exposure to brain or nervous system tissue, usually through certain medical procedures. There is no evidence that CJD is contagious through casual contact with a CJD patient. Since CJD was first described in 1920, fewer than 1 percent of cases have been acquired CJD.

No idea which category this patient had but still.... it's a prion disease that can be transmitted to others and that's what's important! Infection control wanted us to isolate the patient and maintain precautions - whatever that meant! No one told us a thing, just simply wrote an order and left!

Forward 3 hours later and the nurse was checking charts and found this order. Not knowing what to do she contacted infection control who took over an hour to call back and being told that it would be important to isolate and that for any invasive procedures that items had to be incinerated and not simply put into the garbage can OR the sharps container (even though it's a biohazard container).

Now that last bit became REAL important when at the end of shift the code button goes off on the unit and you wait a minute to see if it's real or not - and you make your way to the room to find out that the code is real - then you learn it's the patient with CJD!!!

So then when ppl come running with the code cart and you get all the personnel that need to be there for a code, you have to attempt to tell them all that they need serious PPD - so out everyone runs to get covered up and I go running to get N95 masks because who knows what you're going to be exposed to!

The code is finished and patient is determined to be deceased after several rounds of CPR and epi - so then we contact infection control to find out what to do with all this "stuff" left over and what is required for the body - and we all ask each other - is this a coroner's case - is it a mandatory autopsy?

NOPE! Not a mandatory autopsy - coroner says it's up to family to decide!

HOWEVER - dealing with the body is done differently - I get told by infection control that we need to use an EBOLA body bag!!! WOW! Wasn't expecting that. Didn't even know how to go about getting that! Thankfully infection control says that the ER has it and they can provide it. Whew, what a relief!

Then we work frantically to try to clean up the mess that's left after a code because ALL PPE was piled atop the patient and that simply would NOT be good when the family came and would see this person with "trash" (essentially) piled on top.... but we couldn't just put it in the corner or in the regular garbage. So we called housekeeping and STATed the "special" bags - which thankfully they did.

What a coming-back shift

Dealing with patient's is one thing, dealing with family members is another!

Today was my first day back from having 2+ wks off - having vacation and dealing with a nasty head cold to finally feeling well enough to take care of patients and boy was it a shift.

TWO hours in and my pt was crazily delerious and thinking that birds were in the hospital and we just HAD to "deal with the birds", "the birds, the birds, they're everywhere" - which if I were him, I would be QUITE agitated. So I get it - BUT, when the daughter gets involved and become agitated that I am not doing something to "make him better" - Lady, I've only been with him for TWO hours - I know VERY little about him - just what I got from report and from his history.

So there I am trying to calm both pt AND daughter down - bloody hell, how did this happen to me?!

So off I go to call the MRP to ask for resperidone to manage the hallucinations - nope - he says that he gave orders earlier in the day to the nurse for seroquel and haldol and for me to give this.... ok so off I go to find these "orders" that I knew little about because the day nurse hadn't updated me on these - instead leaving me in the dark!

K so I pull the meds from my pyxis - and fail miserably attempt to give these oral meds - but by this point the pt is so agitated that he is suspicious of what I'm offering.... I attempt several times with different ways to get him to take with no results - dinner comes - and he won't touch it.

That was the last straw for the daughter - she starts cussing at me saying that no one is doing anything to help her father and that he just keeps going down hill. I try to calm her down but that does nothing and starts raising her voice - that's it - straw breaks the camel's back and I inform her that if she doesn't calm the f*ck down that I would notify security (whom is already in the room with another pt) to have her excorted out of the hospital if she can't be respectful. This doesn't deter her and she continues on about how she wants an umbudsman - I inform her that I can get the number if that's what she wants - she confirms this so off I go. I also give the go ahead to the security in the room to notify main security to send someone for back up - and I go get the # as well as notify the MRP about this situation. So by the time I go back to the room the security shows up and informs her that she's a visitor and that if she can't be respectful then she can be escorted out of the hospital. She becomes quite upset and is incredulous about the fact that I gave the go-ahead for security to come.

MRP was irritated that he needed to come speak to this daughter (he said he already spent an hour earlier in the day speaking to her about everything so couldn't understand why she was freaking out now) - and once he showed up she was COMPLETELY calm - and for some reason the pt completly relaxed with him around - enough so that I could get the haldol on board and he talked to the daughter while we were waiting for the haldol to kick in - once that starts to take hold, he allows the doctor to give him the seroquel and clonazepam but won't let me do anything. ERG!!! Well at least he took them! Two hours later he's FINALLY asleep in his bed - may he remain that way the rest of my shift!

Then while all this is happening I have another pt who had IV fluids and IV antibiotics ordered and hasn't had an IV access since nights and the day shift nurse is a tard and ALWAYS leaves stuff (especially the more difficult and time intensive things) for the next nurse - not ONCE did she inform the MRP that there was no IV access!!! Instead she tried to get it, then had a NEW nurse attempt (who is notorious for sucking at IV initiation!) but not ONCE did she contact ICU who have support nurses who attempt difficult IV starts or ICU stepdown to see if they could start it. ARGGGG. So now this responsibility is mine - so I attempt - I could find it but once you start it blows or won't thread.... ARG!!!! So off I go and call ICU (like you should!) as the one senior nurse on our unit who is good at IV initiation said she was "too busy" to try.... so I had to wait for ICU to come.... which they did about an hour after calling - and they get it in the AC but kink the catheter so it's difficult to use.... soooooo I was only able to get the IV antibiotic in and then it went interstitial. So by this point it's after 1930 - which means new nurses!!! So I called ICU and asked that once report is given could they send someone for this guy..... so about another hour goes by and someone comes and attempts 3 times with them blowing each time.... ARGGGG!!!! OK, I'm done..... so by this point this poor pt has been poked NINE times!!! I assessed his feet and they actually look like they're possible - but it requires a physician's order to do. BUT of course SOMETHING gets in the way.... a code blue on the unit next door so off goes the doc to deal with that!

By the time he gets back to our unit it's 2245hrs!!!! I tell him the situation - either a foot IV initiation so that he could get IV fluids, antibiotics and hydrocortisone (steroids) - OR give me an order for these things to be oral.... thankfully this pt was drinking and eating well so while the IV fluids would be helpful it's not URGENT or emergent for IV fluids to be required. Also, the pt wasn't septic so oral antibiotics should be alright til they figure out the IV situation - this pt TOTALLY needs a PICC line!!!! Perhaps I'll tell the MRP to order one for this pt!

Then you have 3 other pt's with required needs, as well as another pt who had diarrhea who required bedpanning four times in my shift as well as a blood product and several nebulizers. Ugh it's just too much for one person and there's no one that I could delegate to :(  Hopefully my next shifts are better!!!

Getting to see big one graduate, seeing family, relaxing and healing

Went to hometown to see big boy graduate from grade 8 - he won THREE awards - including geography which was a total surprise to both him and I! He got one for participating in this math contest where he does university level math - he didn't win from his school but did pretty damn well. For his math course he got 95% on the province wide math test that they give the kids - so ya, I have a little smart E pants on my hands! In his yearbook he said that his goal is to "become an orthopedic surgeon" - if he keeps his head in the game then it's possible. The last time we talked about his goals he talked about how he wanted to get his degree in science then go on to med school.... I cautioned him against this because my hubby's in the boat of getting his degree in biology/chemistry (so a science degree) and not being able to find a quality job (has one now but it took a LONG time) - so I told him that a better bet would to get a BSN - a degree in nursing - because at least that way he's getting experience in the health care field - he's getting knowledge of diseases/conditions,etc... as well as medications - he'll get experience dealing with patients, as well as families - and once he's done the degree he can work PT/casual which in med school or while awaiting med school entrance - I mean who wouldn't rather work for $25+ vs. minimum wage ($10) - and the kid actually heeded my advice and has since decided that he's working towards nursing school then to med school - little does he know that the one med school we have in the province here accepts nursing students who finish their 3rd year.... I think that would excite him.

Amazing how he's only 13.5 yrs old and he's already taller than me and I have heels on!

So after the graduation we spent the rest of the week out at the cottage - and it was glorious.... not really weather wise. I think for the 8 days that we were there we saw 2 truely nice days where it made me hot enough to want to jump in the water! We had fun though, and it was a nice change of pace and allowed me to decompress a bit from school work - I did very very little while I was away.

My mom really did something real wrong.... for 7 years now we've made it a rule that little and big kid do NOT eat pork - when big kid doesn't reside with me I can't control what goes in his mouth and his father wouldn't follow my rules even if I stated this needed to be followed.... but when big kid is in my possession or in my parents, I expect this ONE rule to be followed. I know how much everyone in my family loves pork products so I ensure that when I visit that I am providing non pork options that won't leave someone jonesing for the pork product. I ensured that I had sausage that tasted just like it and turkey bacon that legitimately tasted yummy (It was maple smoked turkey bacon to be specific) as well as morning turkey breakfast sausage patties.

Everything was going great until the last breakfast that we had together - we invited everyone out for a brunch and my  mother decided that she just **had** to make spam - my son's favorite meat (why is beyond me - bacon rules in my mind!) - this year I didn't bring any non pork spam (I have previous years) and so I told my mom in NO uncertain terms that my son was not to have ANY - not a single piece - yep, my mom said,... sure, no prob.... and I got busy making pancakes, turkey bacon and turkey sausage patties - and then my hubby over heard my mom say to my son "take this for you to eat later" - spam is what she was telling him to save for later. UGH!!!! But hubby didn't tell me about this encounter until almost midnight when my mom was already in bed and we were playing cards with my aunt and son  - so I was big time pissed with my son because it sounded like he ate it - we took a break while fireworks went off and I was fuming and had gone into the cottage to cool off and low and behold my mom comes out of her room to go to the bathroom - I told her to "hold up a min, we need to talk" which she did to hear me out and then said it was all my son and she didn't do that.... so off I go to clarify with my son and my husband who BOTH said (son first and hubby verified) that it was my MOTHER who gave the meat to my son. So ya, I was furious! We only have ONE rule that is NON negotiable! The next morning (day we were leaving) it was soooooooo silent - you could literally FEEL the elephant in the room. I got things packed away and then mom and son went outside and were sitting down so I went out there to get it over with - when I broached the subject I just said that I was drastically disappointed with their behavior and that they BOTH disrespected me - that I provided options that made it so that little boy wouldn't feel deprived not eating the pork products and here is my mom GIVING it to him. My mom just walked away from me. I couldn't believe it.

Another crazy thing happened while we were there - the entire week we were super careful with little tyke about keeping her feet on the ground and being careful with jumping and being around the dogs and such. About the 3rd day we allowed her to play in the "park" (on the swing set with a slide) - and we were CONSTANTLY screaming reminding her that she needed to be extra careful on the swing and NOT to be silly!!! Well she was good so we eased off on the screaming reminding her and thennnnnnnnnnn................................ ****BAAAAMMMMM**** she falls on her BROKEN arm!!! And starts screaming about how much it hurts, and she can't move it again - goodness!!! Hubby wanted to bring her straight to the hospital but I told him to just wait for a big and see how things go - thankfully a couple of hours she was using just as before the fall and said that the pain was less. So hubby said he wanted to wait til the next day to go to get an x-ray - before we headed home. Well the next day it was like the fall hadn't happened so hubby and I held off and we got an x-ray when we got back home.... hubby took her as I had to head off to work - he said it looked the same so I relaxed a bit.

So a couple of days ago we had a follow up with the ortho doc and got new x-rays - see below....

Thankfully she's healing and setting new bone down - on the left one you can see the bump on the right side of the broken humerus which the doc says is new bone forming and on the right photo it shows where on the left side of the humerus that the bones are beginning to knit together - all of which is good news - doc said that she may only need the cast for 2 more weeks but that her next x-rays will determine if it will be for longer. Time will tell!!!

A picture's worth a thousand words

But a story puts it into context....

That is little tyke's arm!

I was at work last evening and hubby calls me at about 1730 and tells me that she hurt herself on the treadmill. I was indifferent because she's been acting silly when she's been using it while supervised by me. I figured she got her due for doing something she's been admonished for - figured that maybe she'd learn her lesson the hard way! Hubby told me that she had fallen and hurt her arm and wasn't moving it. I didn't think much of it because if she had fallen from standing she shouludn't have been seriously injured. But I was swamped at work and I went on with my shift.

Around 2200hrs when things calmed down a smidgen at work I called for an update. Hubby said she still wasn't moving her arm, was in considerable pain and wasn't her lively energetic crazy self - so that's major clue #1 - for SOMETHING to stop this kid, something must be very wrong. Unfortunately, hubby had already left for work and no one could bring her to the hospital. So instead they took her to bed.

While I was at work I was talking to evening hospital manager (we're chums) and we were talking about how "we take care of our own" when we're in the hospital or go thru ER - I was "hells no, that hasn't been my experience AT ALL!!!" I told her about my previous meningitis experience and the abcess/fistula times. Then later in the conversation I was talking about little tyke and how hubby said that she was really hurt - she told me that I needed to bring her in just so that she could be cleared. I said that I didn't want to have to wait because I knew certain ER sections would be closed and we would wait FOREVER to be seen.... she said that she would flag my little tyke's name so that we could be seen faster and she would speak to the Dr. there to give him a heads up.

So I got off work - drove the 30 minutes home to pick up little tyke and when I picked her up, just the action of moving hurt (and she was asleep so that tells u the amount of pain!) so I knew that she needed to be brought in to the ER. Drove another 30-40 minutes back to my hospital and checked in. About 45 min later we saw the Dr then 15 min later got the x-ray and immediately saw the break come up on the screen. I believe my reaction was "shitballs!". Went back to the unit and waited for the Dr - another 45 min. He said that he could put it in a sling - I told him in NO uncertain terms that THAT would NOT work for this girl. I told him that her arm would ultimately break further if we just did a sling. So I told him that he needed to find another solution! So off her went.... another 45-1hr later he came back and had me follow him into the casting room where he put a semi cast from the top of her shoulder to her finger tips and then we put a sling on just to support it.

Now we have to wait until tuesday to see the ortho Dr to find out what's going to happen. They could do an ORIF or leave it and hope it heals in alignment. If they want to go the surgery route - it can be done in the first 14 days of injury. The whole issue with all this is that we were supposed to leave tuesday in order to go home and see the eldest graduate elementary school. Now things are up in the air until that appt. AHHHHHHH such stress!!!

Nobody cares

This is slightly a pity post

My birthday came and went - with NO one calling to wish me a happy birthday - sad face

My own kid didn't call me :(  - he "forgot" about  my birthday

My own mom didn't call me - her excuse - well it costs me 50 cents! OH GOSH that will break the bank!!!

My own BFF didn't call me - she says she tried - I saw a text message saying happy birthday but that's as close as it comes :(

I hate giving out the love but not getting it back

My birthday

Two hours ago I turned 33! Wow, where has the time flown to?!

My husband took me out for dinner yesterday - yummy Mandarin - a day early because it was crab leg day (yummo!) and today he made an appt for me to have a "hair spa day" - I get it shampoo'd, cut, highlighted and styled. I'm looking forward to this. It's been a while since that has been done so I'm excited! Especially considering my eldest graduates from elementary school at the end of this month (now I'm just showing my age!)!!!

When my littlest heard that hubby was taking JUST me out for dinner she threw an epic fit! She was aboslutely distraught that we were going to leave her behind. Her words "but you NEVER take me anywhere" - you could FEEL her desperation! Oh the woes of a 6 yr old!!! Funny thing was was that I took her for a special day - just her and I - just YESTERDAY (saturday) and we went shopping and had lunch together. We spent a bunch of special time just us together. We really enjoyed ourselves - so of course I had to point this out and you could tell that she got it even though she was still mightily upset - when I explained to her that she got special time with mommy that it was only fair that daddy also get special time with mommy to celebrate!

When I reach my birthday every year it makes me look at what I've accomplished. I feel like I'm behind the eight ball - it's taken me sooooo long trying to reach my goals. I live with my in-laws, I don't have my degree.... I started this whole road almost 13 years ago and I have fallen and faltered on it. When I look at my best friend I see where my road was supposed to go and where I "should" be right now. I'm seriously green with envy - I want what she has! I want her possessions and position. I hate that I'm in this position because of the road I've had to travel. Then again, without this road I wouldn't be the person I am. I know that my road brought me my loving husband who has given me the strength and support I've needed to pursue my nursing. We've BOTH made sacrifices to try to make our goals work.

This past year I was able to make it through a course that I have struggled to get past and I feel like I've made it around the bend - the one that's plagued me. I only have 5 more nursing courses before I finish this degree and boy can I not wait!

I'm hoping that in this next year I can make it successfully through these courses. I'm hoping that I can make these goals that I have set. I fear failure (who doesn't?!) but I also know that anything's possible.

To the possible!

Planning a mommy and daughter day

About 6 months ago I took it upon myself to take my little girl for a mommy and daughter date

We went shopping then I took her for lunch

We enjoyed ourselves thoroughly!

Then the other day I saw that my favorite consignment store was having a sale this coming weekend.

So yesterday after my Dr's appt I took a swing by and sure enough in the front window they had a sign about their upcoming sale.

So that cinched the deal and told hubby what I was going to do. He wasn't so psyched but gave the go ahead.

Then I told little girl about it and her response was "sure, and then we can go to Popeye's!"

HILARIOUS! It's the one place that Daddy doesn't like to go to so it's perfect.

Now I can't wait to go shopping with my little girl and get it for good prices!