Saturday, October 3, 2015

Question for surgeons

So this is twice now that I've been taking care of pt's awaiting surgery

Both were "on call" to get said surgery

BOTH got pushed to another day (one actually got pushed back two days)

One has a nasty hip (femur head) fracture and the other had a previous G-tube insertion go wrong and they created a nicked bowel and a fistula + abcess.

The fracture was identified two days post admission and then this pt waited another day after that..

So I would think that these would be urgent enough to actually ensure that they're done on the days that they're supposed to.

Additionally, said surgeon (for the most recent one) left before 2130hrs - which makes me wonder why they couldn't have done the surgery they said that they were going to do!

Also - if the surgeon is too tired (as I'm sure that some would indicate as a reason that the surgeon stopped) - at least have the decency to call my unit and tell me this because you ordered fluids that would be appropriate for a diabetic pt who is NPO for said surgery so now I am going to have to deal with on-call to get a hold of an order to have this changed.... because you couldn't just call me and tell me that you pushed your patient to another day!

Lastly - said pt is in major pain - especially when moved (such as when their incontinence brief needs to be changed) - and I'm sure that when you put the pt out for the surgery you will put in a foley catheter - so why didn't you just order it when you did the orders so that at least I don't have to manipulate this pt more than absolutely necessary.

I put myself in these pt's positions - I hate to see them hurting and wish that others thought about these things as well!

Monday, September 28, 2015

What 40 degrees Celcius looks like in picture form

Little tyke is LOVING Pakistan - still affirms that she's not returning (at least not anytime soon!) cuz she's having too much fun!

We're getting snippits of updates for little tyke's activities - I'm hoping that when my other two BIL's and the one SIL is heading over there that I will get more pictures of what's going on and such.

Little tyke said it's hot there - according to MIL it's 40+ degrees and so it's quite warm. So as a way to cool off they headed to the local watering hole to cool off - this is what they found...

She was LOVING every second of it! Just hope she doesn't get Giardia or something from it!

It's kinda hard to make the time difference work for us to talk on a regular basis - it's expensive for them to call here and we never know whose house they're going to be at visiting and depending on the city that they're in determines whether there's internet that would be good enough to support skype and it be clear and smooth.

Today I got to talk to her - she just got to my MIL's older brother's house after having a 10+hr bus ride. She said that she slept the entire ride except for anough time to eat some chips! HA - what a girl!

Saturday, September 26, 2015

She doesn't want to come home - goats are fun - Eid mubarak

Here's a pic of little tyke the second day after she arrived

Little tyke is on the left and my youngest BIL is on the right

Can little tyke look ANY happier?! Also, could BIL look ANY taller in this pic?!

Friday is/was Eid - the goat in this pic is one that will be slaughtered for the celebration - I wonder how little tyke will take that.

Hubby asked me if there was one thing I didn't want little tyke to see when she was there - my response was seeing animals slaughtered.

Let me state this openly and directly - it's GOOD to know where your meat comes from. It's important.

BUT and this is a big one - she's still little and is not raised on a farm - this is not usual practice for her. I think that she would be quite upset if she were to see an animal slaughtered in front of her - especially considering in Islam it's important for the blood to be drained and so when slaughtering the animal the throat must be cut and this appears quite traumatic to see even though it's actually quite humane for the animal.

I hope I get to talk to her tomorrow - I miss her. When asked yesterday (thursday) whether she wanted to come home she emphatically responded "no, never!!!" and ran away!

Oh wait another week or two - we'll see if that changes!

Thursday, September 24, 2015

I got it and you didn't - naner naner naner

We had a pt come in with vomiting and diarrhea - supposedly not unusual for this pt - she's well known to the ED staff

Seemed like she was legit vomiting but also coughing excessively to try to vomit - who knows for reals

Either way, lady was dehydrated and Doc ordered an IV

Now I will preface this that I am quite good at FINDING veins but not always the best and actually getting them in.

So I gathered the necessary supplies and off preceptor and I went

I was able to find a vein but preceptor wasn't able to give it a go in time so I took the tourniquet and when she was ready and I put the tourniquet back on I couldn't get the vein to do its thing again and try to put the IV in

So off she went to put the IV in and poked her about 3 times-ish while I was trying to find another vein on another arm

And while she was poke pokin away at that other arm I actually found a good vein and get it to stick up nicely

I excitedly made that announcement but preceptor wasn't too keen on trying it and I didn't want it to go to waste so I figured that I would try

And holy kamole I actually got it - now the problem - I have NO idea what to do next - I got blood but I am SOOOOOOOO not good with their equipment so preceptor walked me through what should be done in what order to get it to work and I was able to make the IV stick

Success never felt so good!

Wednesday, September 23, 2015

Almost killed my patient (as a student!) and wished I had seen it!

I've been in the healthcare field for like 14 years - I've been a practical nurse for 5 years and I've been working in my hospital on my unit for 4+ years and I can say that I have not actually lost a patient on my watch (technically).

I've had a patient die BEFORE I come on, and AFTER I leave - and where the technicality lies is where once I had a pt died after my shift technically ended but before I was able to give report - so technically the pt died on my colleagues shift.

And pt''s who have actively tried to die on me I've managed to keep living long enough to be transfered to ICU.

Now as a student I had a pt during my last clinical time who had had a knee replacement surgery done - on a replacement that had become infected secondary to a tooth infection and therefore needed to be replaced (so the replaced knee was a replacement).

Well the pt lost quite a bit of blood during the surgery and then when they got to us had put out a bunch (say 700ish cc) in the last 8 hrs and when their Hgb was checked it was found to 8.1 = transfusion certainly needed! So it was our responsibility to set them up.

Here's a foreshadow - pt has a history of A-fib - but it's managed with meds now and pt's on Lovenox

So we put pt on telemetry and start the transfusion slowly - pt's never had a transfusion previously o we explained what reaction sort of symptoms we're anxious about - itchiness, difficulty breathing, hives, flank pain, fever, chest pain, etc...

We wait 15 min - pt says they're feeling the same way so we increase the transfusion slighly for another 15 min and still no change - so we increase it slightly again and my preceptor likes to stay with the pt throughout the transfusion (if and when possible of course!)  so 15 min later pt says that everything is peachy keen (A-ok) so it gets increased a bit more to be about 110cc/hr and we maintain it there until it's time for us to leave - when we left pt was perfect - napping in fact - feeling perfectly normal - including normal sinus rhythm with clear breath sounds and appropriate RR of 16!

So when we got back in the AM and find out that pt is no longer in the building I was shocked to say the least. I ask what happened and am told that nearing the end of the transfusion (say 45 min after we leave) the nurse informs us that pt went into A-fib then v-tach and they tried to cardiovert him by DEFIBRILATING him....

And it fails and they immediately send him to another hospital so that they could deal with this!

Man I wish I could have seen it - just last week (and the week previously) we were going through heart rhythms and that would have been PERFECT to use as a case study for school! Plus to see it up close and actually experience it myself as well as the cardioversion would have been quite the experience.

So ya, loving my site - wish we get more cool stuff happen. Time will tell - but at least I'm still on record for no deaths!

Monday, September 21, 2015

Another round of surgery to be

Life has been rather crazy and forgot to post about the fact that I get to go under the knife again.

Oct. 5th I get to have tubes put in my ears AGAIN!

I'm 33 (not ashamed or embarrased by that fact!) and can't believe that I still need these!

I had my first set when I was 13yrs old - I never realized how hard of hearing I was!

The last couple of years I knew that my hearing was decreasing but was kinda in denial

But with all the other issues I have going on I figured I might as well get that dealt with (plus the whack a doodle immunologist suggested I see one again) with all my sinus and ear infections (plus when I moved to where I am now I never got a new one and the one in my hometown died when I was like 16 (I think)

So when I went to this new ENT (whom I really like) she suggested that I try this new med that I spray up my nose - but turns out that that med is like $100+ and it's not guaranteed to work - so when I saw her again (b/c she only returned my calls once and we missed each other) I explained this and so we've decided that surgery is our next best bet

So now I get to go under the knife - but hopefully it will deal with my issues and help improve my hearing

On the other side....

I saw her after seeing the good immunologist (who didn't do anything but suggest that my ENT do something) and when I relayed that the immunologist wanted HER to do testing on me things went a little weird..... she had NO idea what I was telling her about!

She ended up having to call one of the specialty hospitals to speak to another ENT to inquire about this VERY specific/rare test that the immunologist suggested that I have done => ciliary movement disorder/testing

Knowing my issues I doubt that it will come back positive but at least we can check off one that I DON'T have!

Sunday, September 20, 2015

7 1/2 yrs together but maybe 3 mos in total really

Little tyke goes to Pakistan tomorrow - for SIX weeks! Minus me and hubby. She's going with the in-laws, and the youngest BIL and then in 10 days the other two BIL and the SIL are leaving together and meeting up with them.

I'm anxious for her to go - I think that she will thoroughly enjoy the trip. I'm rather jealous that she can go to Pakistan before I can. I'm not nervous that she'll be kidnapped or hurt in any way because she resembles that side of the family a lot and she speaks the language fluently. I'm not worried that hubby's family will keep her in Pakistan because hubby and I are good - it's not like we're on the verge of divorce or are fighting. And if they keep her there it would terribly shocking and very surprising.

If it wasn't for the fact that I have school and work I would totally be going - I would love to see where hubby was born and raised.

According to hubby where he was raised was just like any other big city - that you have high rises, appartment buildings and subburbs - just like on this side of the world.  So it would certainly be quite the experience to see it myself.

They're going to several of the major cities and she gets to meet all the extended family - good thing she speaks and understands the language - it's neat to see her fluently speak to all the family here. I can just imagine how she'll be when she comes back.

She's all excited about going on the plane - she'll be even more excited when she finds out that the backpack I prepared for her has a few surprises. She's really into these "blind bags" that you know the kind of toy inside (my little pony, my littlest pet shop and shopkins) but u can't see which toy it is - hence the blind part. I know she'll be super uber excited about this stuff. But I told her she's not allowed to play with the backpack stuff til she's on the plane - tho I know that the in-laws will let her have at the back pack as soon as they are away from us - little tyke has them wrapped around her finger and they have difficulty saying no to her - they hate when she has her melt down when they do.

So when it comes to the title - hubby and I have been married for nearly 7 1/2 years but have spent maybe 3 months in total together ALONE - when we were first married we had big boy around most times - he spent some time with his biological father so we had that time but then when I was pregnant with little tyke we  had decided we didn't want to live in my hometown forever and that I would continue with my nursing degree further so we would need to leave - then when I had complications in my pregnancy we decided to leave even earlier because where we live now is close to the hospitals that little tyke would be in if we did deliver early. So we moved when I was 7 months pregnant and moved in with the in-laws and so that meant that for the next 6+years we were NEVER alone - I think we've gone on weekends away maybe once without little tyke - and when we go on vacation we take her with us so ya, we've spent little to no time together alone.

So although I know that I will miss little tyke, it will be nice to spend some alone time with my husband with (mostly) no one around!!! Hubby and I pretty much get 3 weeks solidly alone without ANYONE else in the house - then the other 3 weeks the one BIL will be here but he's solitary in nature and he also works so we'll have little to no interaction with him - so it means that we're mostly alone. Boy I can't wait!

Plus while little tyke is away, there's always skype! We'll talk frequently so it will make things easier ( I think!)

Time to party!!!!