Christmas Eve Eve

So here it is...Christmas Eve eve and what am I doing? I am at work...really I am. I have so much stuff to do, but it will all get done. No need to stress over it. Christmas Eve mass tomorrow...4 pm St Joe's church...finish wrapping Christmas Presents....work tomorrow. Then I am off until the 30th. Then...I am finally on my own, but...I will be at LVH-Muhlenburg...so that is good. Anyway, not much else to say. Hopefully will have some pictures from when we are all together for the holidays. Until then.. Peace love and Happy meals!

Dec 16 2008

What have I learned so far this week...yes, I know it's only Tuesday...
I have learned that if you talk smack, you better be able to back it up. I learned that being flexible is ever present in nursing. I learned that being part of a team doesn't always mean your name will be known. I also learned that I love nursing, I just also know that being by the bedside everyday between now and when I can retire already sounds old to me. I learned that bigger hospitals aren't always the best, and that no 2 ICUs are the same.

New revelations in the world of Nursing

Ok, so I am now officially halfway through orientation. I am now taking 2 patients, although that is not new for me. What is new is trying to balance the 2 patients AND the crazy charting system. I do however, have 2 new tips for this week. 1- I learned to always tell the crazy computer that I infused the bag of medication before I start the second bag otherwise that next bag gets lost in the world wide web somewhere and I am not exactly sure why it needs cardene. I also learned that you can use a nasal trumpet as a rectal tube. This was the first time I did and and once I made sure it was leak proof...it actually does work.

Not much else going on, yesterday was my birthday which didn't really feel like a birthday at all. I guess that happens as we get older. Joe has been working for a week now at Crayola...and while it isn't his dream job, it is a job none the less. Hope everyone had a great week. Look for another post next week. Until then....

Medical Condition #1

So...
Since I don't really have anything cool to write about...I have decided that I am going to post medical diagnosis of the week. Out of all the days I work, I will pick one diagnosis that I think is the most interesting and I will post it. Here is this weeks...

HHNK
Nonketotic Hyperosmolar Coma
Pathophysiology
Most often an initial presentation of NIDDM or in patients with mild NIDDM
Usually seen in elderly population with underlying chronic disease, esp. CV or renal
2/3 without previous history DM
Often precipitated by infection, MI, CVA
Mechanism unknown-Hyperglycemia occurs, but ketoacidosis does not, allowing more severe hyperglycemia, extracellular and intracellular dehydration than in DKA - hyperosmolality results causing mental status changes
Mortality: 20-60%
Diagnosis
Coma or altered mental status - usually cause for evaluation
Profound dehydration, tachycardia, hypotension
Focal neurologic signs (hemiparesis, hemisensory loss, focal sz) not uncommon
Polydipsia, polyuria, polyphagia - may not be known, or overlooked
Visual complaints
Tachypnea , fever possible
Smell of acetone on breath absent
High suspicion in NIDDM, nursing home pt as condition develops slowly (days-weeks)
Labs
Hyperglycemia-glucose > 800 mg/dL [44 mmol/L], usually >= 1,000 mg/dL [55 mmol/L], check serum glucose
No ketoacidosis
Serum osmolarity > 350
Glycosuria
Serum lytes - Na+ & K+
BUN/Cr
ABG (usually without acidosis)
CBC/UA/CXR to R/O infection
ECG to R/O MI
DDx
DKA
Dehydration
CVA
Precipitants include: MI, CVA, GI bleed, infections, pancreatitis, uremia/CRF, subdural hematoma, peripheral vascular occlusion
Treatment/Disposition
O2, monitor
IVF 0.9NS rapidly (1.5L over 1-2hrs) to stabilize BP & keep U/O >50cc/hr; use 0.45% NaCl if HTN or hypernatremia >155mEq/L [>155 mmol/L]; add 20-40mEq KCL/L as soon as adeq. renal fxn. confirmed
Replace 1/2 of estimated TBW deficit during first 12 hours, the rest during the next 24 hours (too rapid correction may cause cerebral edema)
Average deficit is 8-12 liters
Add dextrose to solution when glucose is 250 mg/dL [13.8 mmol/L]
Monitor CVP & I & Os
Reg. insulin 0.1U/kg IVP followed by reg. insulin drip at 0.1U/kg/hr
Insulin requirements less than in DKA
Monitor glucose, lytes, cardiac status, I & Os q.hr d/c insulin when <350 mg/dL [19.3 mmol/L]
Admit to ICU
Consult endocrinologist
Nursing Considerations
Maintain airway and oxygenation
Careful I/O and fluid and electrolyte replacement
Always double check insulin doses in IV bags and syringes w/another nurse
Maintain skin integrity
Provide for pt safety
Provide emotional support to pt/family

It's Beginning to Look a lot like...

...I am working again!! Yay!! I am sitting here at work enjoying some downtime and thought I would post a blog. I love working! Do you have any idea how excited I am to be working again. Oh how I have missed this. I know that I have some wrinkles to work back out again, but man oh man how much I have missed this. I am the lone provider for one patient today, I told my preceptor I wanted to ease slowly back into this, and outside of figuring out the charting I believe I am doing an ok job. Instead of me doing what the minimums are here, I am going to keep myself doing things the Banner way. Not necessarily that that is the "best" way, but it was the way I was taught and I don't want to get lazy. I want to be the best I can be.
I am also going to be going back to school. Something else that I am stoked about! I can't wait to start. Well that is all for now...just wanted to let everyone know that I am in full swing with this working thing...and LOVING EVERY MINUTE!!!

Nov 25th

30 days until Christmas... Can you believe it?!? Holy crap. Just thought I would take a minute to blog about life right now...as it stands... Today is the birthday of both my maternal grandmother and grandfather. Yesterday was their anniversary. Nana said she stopped counting and or celebrating birthdays...I just told her she was 57 today. I started work a week and a day ago...and I am really sick of all these classes. Today I learned about the charting system, which was good to know, but at the same time was really overwhelming. Tomorrow I get to learn about the metavision, which is the ICU charting system, and I get to spend 3 hours on the floor going over more computer work and getting my schedule for the rest of orientation. I just can't wait to be on the floor again..although no so sure I am looking forward to working nights. Today I talked to one of my professors from St Luke's who is now the director at another nursing school and she is looking at me to be a clinical instructor in the spring. I am also looking at going to Kutztown to get my MSN, hopefully I will get to start in the spring. Joe today got the job from Crayloa and gets to be pee in a cup tomorrow morning. Today he decided he wants to go to school for something that he knows will be rewarding...he wants to go to nursing school. So, hopefully he will get that ball rolling. Anyway, that is enough for now, I am supposed to be with Nan and Pop but there are so many people here that I needed to take a break and hide. If I don't post something sooner...HAVE A HAPPY THANKSGIVING!!!

Nov 19thhh

***Disclaimer: this was supposed to be posted yesterday, but the internet was acting a fool, so here is my blog for yesterday....

Ok, So maybe I need to come up with cool titles for my blogs. I am not cool like Jaime to use song titles, and well Rachel is Rachel so her blogs are completely different. Anyway... today was my third day of work at LVH. Stating that, I have learned some awesome things the past 3 days... Some guy who started a gas company out here loved LVH so much that in his will he left them 20 million dollars. Even cooler...LVH pays out their scholarships from the interest gained on the money. Our security guards pack and wear bullet proof vests. They don't have security dogs, but you will get stuck in the elevator. AT&T gives LVH 45% savings on phones....that is almost half off!! I also learned that there is so much more for me to learn. I didn't do so hot on the pharmacology test I had today. I don't think it means anything other than there is a lot left for me to learn. I mean the questions I got wrong were meds I have never used before! How was I supposed to know what they were for?!?! I also learned that with patience comes a whole lot of somethings. While living at my parents may not be the ideal of situations...it works right now. I get a roof over my head and food in my stomachs, and they have Joe and I to do yard work, household chores and even things like finding my mom's reindeer. We also get to spend some quality time with Nan and Pop..as well as any once that goes there to visit. Then there is Shae. Shae by any other name would be cupcake..or well Peanut as I like to call her. I have seen so many different sides to her I get excited to see what she will be like next. Take last weekend for example...Shae didn't nap. She was exhausted and you could tell, but she didn't want to miss ANYTHING!!!. I have spent more time with her in the month since I have moved home than all the other trips home combined. I look for excuses to babysit her, although I can't wait for Dec when I get to put her to bed again. I know that my time with Joey will be shared amongst all the other relatives here in PA, but that is ok. It will be time well spent. I also have flight vouchers that I am going to use in the spring...to spend time with Jaime and Joe and Joey...and maybe if I am lucky kick the adults out so I can spend some quality time with just me and my nephew.

Today...

Well... Happy Veterans Day! I thank each and every one of the soldiers who fought and died for our country so that we can enjoy the things we do today. There are many veterans in my life...one who is so near and dear to my heart...my fiance. He won't say anything, nor does he expect thanks. If you ask him he did what he thought was right.....and he will also say how much he misses Japan. Still... I want to thank each and every one of you! I so truly appreciate it.

Today is exactly 30 days until...I TURN 30!!! I can't believe it. I don't think that I could have imagined my life being the way it is now 5 years ago...and now that I am going onto a new decade of life I hope that the next 30 years are just as wonderful. I have met many people and have had the opportunity to see lots of great places. All have helped change me and mold me into the woman I am. I have no regrets with life...regrets are the devil's paycheck...and he doesn't deserve to get paid. There are things that maybe if I could I would not do them, but regret them I do not.

Can you believe that it is 6 WEEKS...6 little weeks until...CHRISTMAS!!! I am not ready...I will do my best to get ready, but I am not ready now. I now have a niece and a nephew to share the innocence of Christmas with, but still...6 weeks. I can't believe how fast time goes. I can't believe that if you blink your eyes fast enough 2008 will be over. Oh man...

Speaking of Christmas... I am trying to figure out if I want to make a Christmas wish list or if I want to have Joe help me with our wedding registry and just update it or start over...either way giving family the option of getting us stuff on that for the holidays. There is nothing that I really want or need for Christmas. I am back home with my family which in all honesty is really all I wanted for Christmas. I will be surrounded by people who love me...both my family and my future inlaws. I can probably come up with stuff that I would like to have, but living with my folks it is a little hard to "store" things for when we move out. I will just keep thinking about what to do and when I come up with an idea...I will share....

That will bring me to a STRESSFUL 2009. Only stressful because I will be planning the most important day of my life...and one of the most romantic days in my life...my wedding. I am trying to do a little planning every weekend, or every other weekend, so that when the new year comes I won't turn into this Bridezilla that goes all berserk bc well quite frankly I know that something will go wrong...something will not go as planned, but the best part is no one else will know except me. Joe won't even know... So while I want to plan on it being the best day of my life...which I am sure it will be...I am also trying to keep myself grounded by doing that there is only so much I can do and whatever happens happens.

Life

So...life throws you some curve balls even when you think all is planned out. It took to long for the wonderful commonwealth of PA to process my license information, so I haven't started work yet :( I will start however Nov 17th...which guarantees that I will have off for Thanksgiving and Christmas. My sister Jaime had a beautiful baby boy named ----> Joseph Michael on Halloween which as my sister Rachel pointed out means that he will be a prankster. That is all well and good however, but Rachel also continued to point out that her daughter...my niece Shae (seen below) is going to be the Joker of the family (Shae's b-day happens to be on April's Fools day). That being said, these 2 wee ones are the loves of my life. I can't wait to get to see Joey and love on him, and when I see Shae on the weekends she melts my heart....well especially when she calls my Fiancee's name or accidentally mistakes him for Pop-pop. Anyway, I am just trying to survive until I start work, but until then...I have these 2 little ones to keep me happy.

New Job!!!

So...this is where I will be working...------>

I am the newest employee at Lehigh Valley Hospital...I will be working on the MICU/SICU 7p-7a....they don't do as much as my old banner home, but I am still excited. CVVH is a skill that I will get to learn...but that is not for a little while yet. I start November 3....I will be on orientation for 6 weeks...so for the first 6 weeks I won't have weekends nor holidays to work...I will have a M-F 7-430 job...I don't know what I am going to do. So...now that I am employed...I am just waiting for Joe to get some work...which incidently he also heard from Lehigh Valley Hospital...he is trying to continue his work in behavioral health so he is going to try to take the CNA job there and well that is always good because there will always be work there. Well that is all I have to update on..hope all is well.

Pics

So I finally was able to upload some pics from my camera...and found 2 from the last time I was home... Enjoy

And the countdown has begun...

1 more day of work this week then a mini vacay with Rachel
2 days of hospital work next week plus
3 days of clinical instruction then...
FINAL 3 days of hospital work
4 days in TN (YAY Phil and Kim)
2 days of clinical instruction (a good way to avoid the movers)
1.5 days in TX (quick stop to visit and sleep...no hotels;)
1.5 days in Chicago (finally get to see Jaime's house + no hotel)
then finally PA...
that is all I have left

Moving...

In case anyone wanted to know...it is now official...WE ARE MOVING TO PA!! We are leaving Oct 9th and hope to be in PA no later than Oct 12. We are not sure where exactly we want to live, right now the only interview set up is Oct 15th at UPMC St Margaret's. While there we will be taking a little tour of Pitt...and look at a house for rent. I will keep you all posted. Pitt by the way is the halfway point from Easton to Chicago...so hopefully everyone will get to see us. I will keep you posted on the move...PA HERE WE COME!!!

Coming Home

So...I will be home August 20-25th. On the 23rd at 11am we are probably going to go to Davids so I can try on my wedding dresses for everyone. Everyone is welcome! Just call my cell if you are coming so that I can make sure we are all there. Can't wait to see everyone!

Schtuff

So this week has been very wedding productive...
We have a florist... www.flowersbyjodi.com to see her work
We have a photographer... www.momentsinfilm.com
We think we have a reception hall... key factor there...
We have a location....and a date...
We think we have a dj....
All we need is a cake... and a time...
Hair is a check as well as makeup...

Quick question... is a cash bar tacky? or is it ok after we pay for so much of the alcohol up first and then when our allotment is spent then we do a cash bar?

Wed

Wednesday is not just another ordinary day..on Wednesday I get to hang out with my lil sister! For those of you that don't know it, I am a volunteer with Big Brothers Big Sisters, and I am a big sister to a 9 year old girl name Shania. So tomorrow (weather permitting) we are going swimming and hanging out and doing cool stuff that 9 year olds do. Anyway, look for pics...I will ask for permission from Shania and her mom, but if I can't take pics of her at least I can take pics of what we do! Anyway...that is all for now!

Exciting News!!

To those of you that don't know it...
I am on a personal mission to look the best I can for my wedding (that is my long term goal) and my short term goal is to just look healthier and feel healthier the next time I see ya'll. So today at the gym I got on the dreaded scale...I hate that freakin thing...and it said that I have lost 10 pounds! I am stoked!! I can't really see the weight loss...so I am thinking that it is pretty much from everywhere, but puts my 2 miles and 500 crunches in perspective...which has pretty much motivated me to go or try to go every day! I just know I can do it!
I am not trying to rub anything in anyone's face.....it's just the little things that get me excited...I want to be a size healthier, a size more energetic, a smaller size version of me.

So...

So I know that my life is boring. BAHORING! I am not expecting a baby, nor do I have one to take cute and witty pics of. But..here is a pic of my children. And this is them at their best.

My job.

My job ceases to amaze me. Really. Who knew that you could love your job so much after resenting it for so long. Anyway....this is where my job gets really cool...
Yesterday I took care of a patient with an at the knee amputation. Ok so normally it is either below the knee or above the knee, hardly ever at the knee. Anyway...his dressing was getting saturated and I wanted to change the dressing. So I did. Well I don't know what I was really expecting because I never really saw an at the knee amputation before, but at the same time I wasn't expecting what I saw. Anyway, as I was taking down the dressing, there staring at me was....A HUMAN FEMUR! I freakin saw a human femur that wasn't on a skeleton!! I almost had a heartattack. I mean I wasn't grossed out, just not expecting to see a femur. Usually amputation sites are sewn shut....not this one. But I can now say that I saw a human femur and now I can move on. Ohh...and I want to thank those Ortho docs that I worked with in Texas. Who knew that if you actually listen to them their ideas work ;) I didn't have to change my dressing all day!

Today

Well since I last wrote, I have done some more thinking. Even after the gym I came home and felt clastrophobic. I am now beginning to understand what it is like to be stuck in a hospital room with nothing else to do but watch paint dry. Anyway...I decided that before I completely lost my mind I would take Scout Thomas and Gizmo Marie on a walk. The following pictures are proof that my dogs walk me.

This past weekend...

So...this weekend was my weekend to work, which I did, but nothing else too exciting did happen. (However, I am no longer sickened by sputum, especially thick sputum that trached patients manage to cough across the room) I am however really putting some thought into moving back east. I AM happy here, but not as happy as I know I can be if I was closer to family. So there...now you know that I failed at living away from home...failed at living on my own. Anyway...nothing is set in stone, all I know is I want to be able to drive home in half a day...and drive to see Jaime in half a day. In other words...somewhere anywhere other than here. Our current lease is up in March....so maybe one more winter here before I shock my body back into east coast winters....then there is the whole find a job thing...and the moving thing....I did apply for a teaching job at St Luke's Hospital School of Nursing, so I will find out if I am even a candidate to do clinical instructing there. Until then...I have no idea what is going on in my life...I just know that while Joe makes me unbelievably happy, I can't rely on him to make me completely happy. So...I am sorry to say that I failed out here....I tried it...I did..I really did...and now...this show must end and I believe I need to move back home. "So I'm coming home, back to the place where I belong And where your love has always been enough for me. I'm not running, no I think you got me all wrong I don't regret this life I chose for me But these places and these faces are getting old." (Thanks Daughtry- I don't think I could have said it better myself)

Thinking...

Ok...
So I am sitting here thinking about a lot of things...and yes I do mean A LOT of things...
Again the wedding color has changed...so now we are in the blue family. Green wasn't going to give the wedding the look I wanted. And the official color won't be picked out until I find my dress....
To my niece Shae...I am soo sorry that you don't even know me. I am soo sorry that I am a horrible aunt. I promise one day we will meet and it will be love at first sight. I can't wait to see you and hold you and hug you. I can't wait to hear you start talking and asking for me...but I know that won't happen until we meet...I promise...I am doing my best to get there soon...just have some faith that I sit here and love on you without you even knowing me..
As much as I love it out here, I am starting to wonder how much of a toll this will take on me. I don't like it that I don't get to see my family nearly enough...that I have yet to meet my niece, and that I just can't go wedding dress shopping with my mom and aunts. I guess all in all I need to sit down and find out what is a perfect fit for me...for crying out loud I need my family but I need my space too!

Update..

Ok...so the date has been changed...it will now be August 8, 2009...it will be a Saturday...and Joe has chosen Clover Green as the wedding color. So the location has stayed the same...just the date and now the color has been picked. I will keep you all updated and informed. I am going to look at dresses this week, just to get an idea of what I like. Stay tuned....

Wedding...

So, a date (7-8-9 ) and a location have been set. We are slowly making plans but I at least wanted to share with you pictures of the place where we will be saying "I do!" These pictures are old, so some of the shrubs are more matured now, but at least you can get an idea of where we will be...and the set up for it.
In this picture you can see where Joe and I will be standing. Each bridesmaid and groomsman will have a step, with the final bridesmaid standing on the level ground.

the pool with floating fire a beautiful addition to our day!

Family...

Well..As you know I graduated this past weekend. And as you also might know my family was here. So...Here are some pictures of graduation, the people I met and the good stuff we did. I am sorry, I was unable to take pictures of dad walking the dog however those will be taken his next trip out here. Nana Robbie and Poppop Scout and Gizzy miss you already...

Doggie

Gizzy
Gizzy
Gizzy and Scout...
Sleeping...it's their favorite hobby

Spring Training...Cactus League

Sometime in end of Feb or early March...Spring fever hit...I finally went to see a Spring Training baseball game...IT WAS LOADS OF FUN!! Nothing like watching baseball from the outfield lawn. So...here are some pics...

Love is in the air...

Nothing else to do on a Sunday

So...my life thus far has been interesting. However, I am not bitter. I have learned from mistakes, learned from other people. I guess the best part of being who I am is that I have learned from everyone and everything around me. My life is nothing extraordinary...I am not a new mom, not doing anything that some would seem exceptional...I am just living for living. On May 3rd, I graduate with my BSN...yes, another degree. But this desire to learn has led to me knowing that I won't be satisified with that degree. I do feel another degree in my mists...but...that won't start for at least a year...maybe 2. Once I am done with school this May...I am going to be focusing a lot of time and energy on learning how to be a GREAT ICU nurse. Not the typical run of the mill kinda, but a great one. My parents are coming out in 10 days! I can't wait. I feel like I haven't seen them in forever, yet I know their time here is going to go by way to fast. All I can assure you is that there will be pics...pics of whatever it is we do. Well...I don't know if there is anything else for me to say right now...I gotta get some homework done. So...I guess it is...BYE FOR NOW!