Sweat Sweat Sweat

So...
Today is the first Monday of 2009 and what did I do? I was at the gym at 0530. I met with the Physical Therapist that runs the gym and although I am really overweight, the consultation wasn't terrible. I did 80 crunches in 60 seconds, My hamstring flexibility is better than average as well as my hand grip strength. Doing squats kicked my butt, which I have a feeling I will feel well into tomorrow. I go back on Wednesday again at 0530 to meet with him again. This time it will be the first of 2 more consultations, this time laying out my workouts. I am planning on working out 4 days/week for at least 60 mins a session, so I know that 2 days a week will be upper body the other 2 lower body but all four days will be cardio. Hopefully...since work pays for it, I will be able to keep up the work so that come August 8th...I will be in the best shape possible and I know that it will be the best shape I have been in in a long time :) I will keep you posted. Keep your fingers crossed for me!

Pom and circumstance goes here...

Right now it is exactly 0153 on 1/2/09 and I am at work. This is blessed down time, but gives me the opportunity to state my goals for 2009. I chose not to do resolutions bc quite frankly I break them...sooo if I make goals then it seems like I shouldn't break them. First things first...I have almost every cotton picken piece of paper needed for grad school filled out. I am just waiting get 2 out of 3 references back and then I will send them all in to Kutztown. Sooo in case you haven't guessed getting my Masters or at least start my masters is a goal for 2009...can't really say that actually achieving it is my goal for 09 bc well...I won't have it by the end of the year. My second goal is to stay sane while planning my wedding. I have exactly 7 months and 6 days until I say "I Do" and I have already filled my planner with to-dos. Hopefully I will be able to keep my cool and do the little things one step at a time. My next goal is to spend more time with my family... I mean that more so in the sense of taking time to spend time and listen to my family. As a nurse my life is usually hurry up and get this done or hurry up and get that done, that when I am at home I am not exactly one to RELAX. I am not even sure that that word is in my vocabulary. This past week the entire Haldaman clan was in one house...and ohh how much smaller my folks house seems to have gotten. This week I fell apart bc I felt that my sisters and I were drifting apart bc they share some special bond that I am not a part of and that by the time I do share that bond it will be water under the bridge. I am ok now...I realized (after talking to Jaime) that there are things that we still have in common that being a mom shouldn't be a deciding factor that we are drifting apart. After that discussion the last couple nights with all of us in one house was actually enjoyable. ...Ok so one more goal that I can think of right now...I hope to at the end of the year...yes even after Joe and I are married is to be finally in a house, and not renting it, but owning it. I know that that sets me up for stress...but I believe that Joe and I can do it. And where there is a will there is a way. Anyway, that is enough for now.... I need to actually do some work right now... Take care! Peace love and happy meals!

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!!!