There are times when a lot of attention and resources are focused on a problem, that once addressed and the diagnostics are resulted...
The family of the patient, becomes the patient(s).
A life-ending condition, does not mean the end of an ED Nurse's attention. The immediate patient's needs still will be addressed. However; it takes an experienced ED Nurse to realize that they now have another, if not a few more, patients in the same room.
Comfort Care is usually thought of as making a terminal patient comfortable. Elimination, pain control, etc. That is just the surface, the overt actions one takes. It is the call to the Hospital Chaplain, the Case Manager or Social Worker; the breaking of "the rules" and allowing more than the allotted number of visitors at the bedside, answering questions, providing support, and most importantly...
Being present.
Monday, January 27, 2014
Tuesday, January 21, 2014
I worry about the patient, that doesn't complain...
An ED secret, perhaps?
Pain is subjective, I know. I have experienced pain. My abdominal pain caused by appendicitis, as a seven-ish year old, was a 10/10! My back pain caused by a herniated disc, was an 8/10. Both required surgery to fix. My dislocated thumb, self-resolved after a motorcycle accident, was a 4/10... the sting of air on my road-rashed arms, for a short 2 mile ride into a town... 15/10! Almost considered an overnight stay... H2O2, a few bandages, and a new jacket, got me home the same day.
Yet, it is the 'quiet' patient... that waits for hours, without ever asking "how much longer?" Just the look of relief, when there name is called, and a hand is raised... the one that you have to go get a wheelchair for, just to get them back to the treatment area.
Perhaps I am biased.
Adults, are not that different from babies. I like crying babies! They have the energy, reserve to continue, and are generally pissed off that they are being poked, prodded and bulb-suctioned... that means they are generally healthy and will fair well... It's the lethargic, pick them up and they don't care, don't cry from the separation from parents, kind of thing that alarms me!
Pain is subjective, I know. I have experienced pain. My abdominal pain caused by appendicitis, as a seven-ish year old, was a 10/10! My back pain caused by a herniated disc, was an 8/10. Both required surgery to fix. My dislocated thumb, self-resolved after a motorcycle accident, was a 4/10... the sting of air on my road-rashed arms, for a short 2 mile ride into a town... 15/10! Almost considered an overnight stay... H2O2, a few bandages, and a new jacket, got me home the same day.
Yet, it is the 'quiet' patient... that waits for hours, without ever asking "how much longer?" Just the look of relief, when there name is called, and a hand is raised... the one that you have to go get a wheelchair for, just to get them back to the treatment area.
Perhaps I am biased.
Adults, are not that different from babies. I like crying babies! They have the energy, reserve to continue, and are generally pissed off that they are being poked, prodded and bulb-suctioned... that means they are generally healthy and will fair well... It's the lethargic, pick them up and they don't care, don't cry from the separation from parents, kind of thing that alarms me!
Sunday, January 19, 2014
Days off!
What a wonderful blessing!
In today's age, they are often more structured, full of deadlines, and rushed for most... then a typical day at work.
And this, makes me frown.
Yes, the grass needs to be cut, tree trimmed, wall painted, groceries bought, car worked on, etc. Yet, those things needed to be done a few days ago... and if not accomplished today, will they not still be there tomorrow!?
When I am at work, I am focused on what I do. I have to prioritize, interact, delegate, juggle tasks, and believe it or not, sometimes just stop to give an individual something only I have... my time.
So, on your next "day off," see if you can find it.
In today's age, they are often more structured, full of deadlines, and rushed for most... then a typical day at work.
And this, makes me frown.
Yes, the grass needs to be cut, tree trimmed, wall painted, groceries bought, car worked on, etc. Yet, those things needed to be done a few days ago... and if not accomplished today, will they not still be there tomorrow!?
When I am at work, I am focused on what I do. I have to prioritize, interact, delegate, juggle tasks, and believe it or not, sometimes just stop to give an individual something only I have... my time.
So, on your next "day off," see if you can find it.
Saturday, January 18, 2014
Bad Uncle...
My niece turned 21 today.
Took a ride to help celebrate, gathered with extended family.
I was the "Bad Uncle." My gift to her, was some wine. Although, the lottery tickets, a close second! Naughty G-Parents!
It went over better than I expected. Probably much better than my original, albeit devious, idea. I shall reserve it for future use. There are a few more, younger family members... and by then, a few more older ones too... (not sure if a hehehe or a mwah haha is appropriate!)
According to her parents, her first "legal" drink occurred at a later family dinner. A strawberry daiquiri. I was imagining some salt, lime, and tequila... as a willing victim of aforementioned... to this day, I still proclaim that it is the best deterrent to future consumption!
Turning 21, is an artificial milestone. It is an age that society determines that one is old enough to be able to make a personal choice. There are others as well... 15 1/2 for a learner's permit for driving, 16 to get a job, 18 to become a pseudo-adult, 21 to be able to drink alcohol and gamble...
After presents, cake & ice cream, the gathering eventually broke apart. I wonder if my niece understands how lucky she is? Her Great-Grandmother, Bo-Nana, a centenarian, attended this get-together! I know my youngest niece did, her younger sister... held Bo-Nana's hand and helped walk her out. There's an untold story there... only her's to tell.
The "Bad Uncle," rode home.
Took a ride to help celebrate, gathered with extended family.
I was the "Bad Uncle." My gift to her, was some wine. Although, the lottery tickets, a close second! Naughty G-Parents!
It went over better than I expected. Probably much better than my original, albeit devious, idea. I shall reserve it for future use. There are a few more, younger family members... and by then, a few more older ones too... (not sure if a hehehe or a mwah haha is appropriate!)
According to her parents, her first "legal" drink occurred at a later family dinner. A strawberry daiquiri. I was imagining some salt, lime, and tequila... as a willing victim of aforementioned... to this day, I still proclaim that it is the best deterrent to future consumption!
Turning 21, is an artificial milestone. It is an age that society determines that one is old enough to be able to make a personal choice. There are others as well... 15 1/2 for a learner's permit for driving, 16 to get a job, 18 to become a pseudo-adult, 21 to be able to drink alcohol and gamble...
After presents, cake & ice cream, the gathering eventually broke apart. I wonder if my niece understands how lucky she is? Her Great-Grandmother, Bo-Nana, a centenarian, attended this get-together! I know my youngest niece did, her younger sister... held Bo-Nana's hand and helped walk her out. There's an untold story there... only her's to tell.
The "Bad Uncle," rode home.
Saturday, January 11, 2014
Public Service Announcement:
Influenza (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly. People who have the flu often feel some or all of these symptoms:
- Fever or feeling feverish/chills
- Cough
- Sore throat
- Runny or stuffy nose
- Muscle or body aches
- Headaches
- Fatigue (tiredness)
- Some people may have vomiting and diarrhea, though this is more common in children than adults.
If your child or grandchild develops any of the above symptoms, see the previous paragraph.
You should only go to the Emergency Department if you have a pre-existing medical condition, such as asthma, COPD, CHF, etc. and have an exacerbation (worsening) of those conditions. Children should only come to the Emergency Department if they are vomiting and unable to take medicines and fluids.
Likewise, please take and/or administer, acetaminophen and ibuprofen for fever. The ED Personnel will believe you if you report a fever of 102+ at home! Do not withhold medicine to "show" or "prove" how high a fever is. Also, invest in a simple thermometer, they can be purchased for less than $3.00 at many stores. The difference means unnecessary blood tests, urinary catheterizations, IV fluids, x-rays, lumbar punctures, etc.
Unless the patient has a pre-existing medical condition that has been exacerbated, or severely abnormal vital signs, influenza by itself is not a medical emergency. Expect to wait to be seen. In addition; if the patient has a non-influenza related illness, after waiting several hours in an ED Lobby they will more than likely be exposed to influenza...
Thursday, January 9, 2014
Tuesday, January 7, 2014
Monday, January 6, 2014
Sunday, January 5, 2014
Saturday, January 4, 2014
Disrhythmia...
An abnormal rhythm.
As a Nurse, as an Emergency Nurse, and as a former Paramedic... I know disrhythmias! Abnormal rhythms! Usually used to describe cardiac (heart) abnormalities.
I met myself a few days ago. Not really myself, just someone very similar to me. A Paramedic, who was interested. Wanted to stay, watch, ask questions, learn...
He showed me the EKG (ECG) strip, which his machine identified as Sinus Tachycardia, and he was reporting to me. I asked him, where is the "P" wave? He identified what he thought was...
I asked him to watch.
A simple val-salva technique. A vagal maneuver, temporarily slowed the heart rate to reveal the true underlying rhythm.
Nothing he had at his disposal, could have affected this. Therefore, no harm, no foul.
A 1:1 Atrial Flutter, is somewhat rare. Those "P" waves the machine and he saw, were 'flutter' waves. Yet it was in the 'zone,' so to speak, regarding rate. Slowed, the 'saw-tooth' pattern was evident. A few minutes later, Atrial flutter in a 4:1... an hour later, back to baseline.
The difference between an emergent cardiac catheterization, and an admit for monitoring and further non-emergent testing.
As a Nurse, as an Emergency Nurse, and as a former Paramedic... I know disrhythmias! Abnormal rhythms! Usually used to describe cardiac (heart) abnormalities.
I met myself a few days ago. Not really myself, just someone very similar to me. A Paramedic, who was interested. Wanted to stay, watch, ask questions, learn...
He showed me the EKG (ECG) strip, which his machine identified as Sinus Tachycardia, and he was reporting to me. I asked him, where is the "P" wave? He identified what he thought was...
I asked him to watch.
A simple val-salva technique. A vagal maneuver, temporarily slowed the heart rate to reveal the true underlying rhythm.
Nothing he had at his disposal, could have affected this. Therefore, no harm, no foul.
A 1:1 Atrial Flutter, is somewhat rare. Those "P" waves the machine and he saw, were 'flutter' waves. Yet it was in the 'zone,' so to speak, regarding rate. Slowed, the 'saw-tooth' pattern was evident. A few minutes later, Atrial flutter in a 4:1... an hour later, back to baseline.
The difference between an emergent cardiac catheterization, and an admit for monitoring and further non-emergent testing.
Thursday, January 2, 2014
Happy New Year!
Amazing at how quickly 2013 went by!
The other day, I had the privilege to provide care for two patients in an overlapping time period, that I thought, defines what it is all about. It is almost cliche!
A nonagenarian, and a neonate. Two patients, almost a century apart in age, with a similar problem!
Balance.
There is a side story, which I can't divulge any details about due to HIPAA... just know this...
Between the two patients and the families, there were a lot of smiles and thanks being shared!
One knows, one will never know. And two of us, shared a smile...
The other day, I had the privilege to provide care for two patients in an overlapping time period, that I thought, defines what it is all about. It is almost cliche!
A nonagenarian, and a neonate. Two patients, almost a century apart in age, with a similar problem!
Balance.
There is a side story, which I can't divulge any details about due to HIPAA... just know this...
Between the two patients and the families, there were a lot of smiles and thanks being shared!
One knows, one will never know. And two of us, shared a smile...
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