Tuesday, December 23, 2008
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!
Tuesday, December 16, 2008
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.
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.
Friday, December 12, 2008
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.
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....
Friday, December 5, 2008
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
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
Tuesday, December 2, 2008
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!!!
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!!!
Tuesday, November 25, 2008
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!!!
Thursday, November 20, 2008
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.
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.
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