Friday, February 28, 2014

Seemingly I worry for nothing

Just got back one of my marks for an assignment for my mental health course. I was so incredibly worried about it. I completely felt like I bullshitted my way through it. Well evidently my teacher likes my Bshit because he gave me 98%!!!

I have a medication assignment due for Sunday, I'm only 50% done it. It's not a difficult assignment, just time labourous.

I have a major paper due for my ethics course tomorrow. It was supposed to be due today but I ended up with a stomach bug or something and was heaving for a good 24 hours and couldn't get enough energy to even lay on the couch let alone get onto the computer and finish a paper.

I have all the quotes done, now I just have to arrange them and fill in the blank areas to tie everything together. There was sooooo much research to do for this stupid paper. My topic was: should it be legal to buy organs. IMO I think there should be a system in which you can. You pay for your medical care in the US so I don't see why you can't purchase something you need in order to live. It benefits the donor as well who would be able to donate something and receive payment for it. I think it can be regulated and can be safe guarded to ensure that there's no coercion or manipulation. I doubt, however, that it will ever come to fruition because people don't care that you can prevent people from dying, it's all a money game - those who earn the most control everything and so they'll keep the system the way it is right now.

Tuesday, February 25, 2014

Midterms - bane of my existance

I completed my exams yesterday...

My mental health course I bombed - 67% bombed - brought my course mark down more than 10% - EEEK.... not impressed with myself. It's my own fault though, if I had done my reading as I should have then I wouldn't have done so terribly.

Note to self - even if you think that you know your shit, that doesn't mean that you can't do the readings... this teacher's stuff actually comes from the text - no wonder I bombed!

My ethics course was sooooooo messed - it was 10 ethics questions and you had to support your position with at least 2 sources, which = a LOT of researching and reading which = a LOT of time. No wonder I bombed my OTHER exam, I didn't have TIME to do the readings because I was too busy doing this stupid exam. I had BETTER get an amazing mark!

Oh and I had to work this weekend so there goes 72 hours of potential study time.

Hubby of course lectured me, told me I should be working harder and studying more.

I admit that the motivation to study has been lax lately, I totally need to pull my pantlegs up and work more but I honestly dislike these courses so how am I supposed to be motivated for this crap?! HEEEELLLPPP!

Sunday, February 23, 2014

Getting back on the horse

I went back to work. First day wasn't too bad. A LOT of new orders.

I have a patient with Ogilvie syndrome - it's like uber megacolon - the colon is SUPER dilated but there's no mechanical obstruction. My pt got a NG and rectal tube - he's full of air on both ends. When the surgeon was putting the rectal tube in the pt started belching majorly and passing excessive amounts of gas. And the NG was hooked up to suction - then the Dr came in today and decided to run PegLyte (bowel prep medication) but didn't write an order to stop the suction. So of course I had to call him for that. Which of course I got the order. But this guy also has an IV running and a foley so we have to watch the IN&OUT... which when I added it up during shift change he was sitting at a fluid EXCESS of +400mL. I notified the Dr of this and he wasn't concerned about this AT ALL - except that in my opinion it was only going to get worse because this guy's clearance was <30cc/hr and we're running his IV at 100 which means his fluid excess would just get higher and higher. Dr said that until his scrotum became the sizes of watermelon not to notify him of the fluid excess. He asked me what I wanted him to do - I said some Lasix would be nice. Shot me down on that one - said that his kidney function was already going kaput so that wouldn't really help. I asked HIM what we were doing for this guy then - why have the IV if you aren't going to do anything about the excess. I was told that he wants him to be a DNR but that family won't approve - that they are living in a fantasy world of denial and think that he can improve...

Let me paint this picture for you about this guy -

* Bilateral stroke (rare and very detrimental)
* Obese
* Diabetic
* 2 previous MI
* Blind (due to the diabetes)
* and this bowel issue
Now, if I ever had a family  member with this sort of picture - hello DNR! But they just don't get it - no matter how many Dr's talk to them - even our best palliative doctor. I hope this guy codes on someone else's shift and not mine!

Monday, February 17, 2014

It's taken 8 months but no baby out of it

I get to go back to work this week. I've been out of work for 8 months. Such a long period of time. And I don't even get a baby out of the deal. Bummers!

I'm looking forward to it. To getting back in the groove of things. Plus I seem to get the weird and crazy stuff. I'm ok with that as long as I don't get the weird and crazy patients. I hope we have a good set of hospitalists - the ones who will actually listen to nurses.

I can't wait to start using my skills again. The only down fall is that I won't have as much time for my readings, my assignments, and my tests/exams. I'm actually starting back at the work time because I have a MASSIVE exam due by friday afternoon, 2 quizzes that are killers and two major papers. I should be stressed out more than I am - maybe I just don't know any better.

One thing that's frustrating for me is that I'm not getting many marks back from the courses. I've done two assignments in the one course and haven't gotten any marks back - and they've been completed for like 3 wks so I would expect results by now. I don't really have any choice but to wait.... I hate waiting though.

Thursday, February 13, 2014

Almost back to work

Talked to Oc health today, about the same 'ol stuff. It's like they don't listen. Go figure.

I'm supposed to start back to work next week - very excited about this. I didn't think I would miss it as much as I do.

Spoke to my charge nurse as well to let her know that I was going to be coming back next week for my expected shifts.

Clinical is coming up as well. It'll be nice to follow up with my little old lady about how her social event this past week that she contracted with me for. I'll be surprised if she actually enjoyed it but there's always a chance at her surprising me.

Valentine's day is tomorrow.... little tyke is UBER excited about it. We got her special ones this year since it's her first time. We were also going to make cup cakes but her teacher told me that no outside food was allowed in the classroom - MAJOR disappointment! Hopefully all the kids will be happy with what we got. We'll see though.

Monday, February 10, 2014

Actually enjoying clinical

I've gone to clinical twice now and was really, really worried that I would hate it or that my clinical preceptor would hate me. Turns out we click BIG TIME!

Terry (not her real name) is a gorgeous outgoing black african american woman who is wonderful. I get to her house an hour before we leave, just to speak about how our day is expected to go, the type of patients we'll be seeing and what she expects of me. I like this because then I know what to expect and I can try to make sure I meet them.

One of the patient's we have is a 90+ woman who lives several states over from her only surviving child, who is a boy and he acts like one. My pt complains that they don't have a good relationship and that she has hinted that she would prefer to live closer but doesn't say it exactly like that so it's not like he recognizes it and so as time keeps going on she just gets more and more bitter. (my mom is the same way with one of my brothers so it was ironic that I could totally see it in this exchange) She is depressed and anxious and has openly admitted that she wants to die but won't commit suicide (as per her religious beliefs). She isolates herself because all of her exchanges with the people in her retirement home alienate her. I found it difficult trying to counsel her on changing her behavior. I just don't have the knack for these things. What I DID do was talk to her about her self isolating behavior and to make a verbal agreement to go to a social event at least once this week and she was required to sit by someone she hadn't previously communicated with and when we meet this week we would talk about it and how it went. I hope it goes well!

Then after our day we go back to her house and debrief how our day went. She complemented me (YAY!!!) about how well I'm doing and that I met her expectations for our day.

I will be VERY excited when this rotation is done and over with - just hope it's successful!!!

Thursday, February 6, 2014

If I haven't said it before I'll say it now...

I HATE SNOW!!!!!!!!! Hate is a VERY strong word. I've tried to teach my kids this. I HATE my son's father - he tried to ruin my life (almost succeeded too), I have good reason to hate the guy. So what has snow done to make me hate it so?

We (the southern part of my province) got DUMPED on - amounts that I haven't seen since I was a kid (yay global warming). If I had known that we were going to get THAT much snow I wouldn't have taken little tyke to school, I would have kept her at home. When I opened the door this morning it had already snowed a bit - I thought we would be ok. Me getting ALMOST stuck should have been a clue to turn around and drive back home and not worry about having to go out again later in the day. Ya I'm an idiot - figured that the snow plow would be by before school let out and we would be good to go.

Not that lucky I'm afraid. So off I go without snow boots (remember I hate snow, but I live in a world of denial about the weather I have to endure) with a sweater (again, denial)... and just about get stuck on my road!!! OOOOoooo was I regretting bringing little tyke to school!!!

But made it I did and I made it home as well (thank the good lord!) - note to self, if you see the snow accumulating, DON'T GO OUT IN IT!!!!!!!!! Stay home and stay warm!

Monday, February 3, 2014

Advance Directives - AKA Living Wills - power of attorney - my thoughts on these

For ethics I have to read two positions on this. Funny thing is is that I have personal experience with this - outside of my role as a nurse.

About 3-4 years ago my mom's good friend Jane (not her real name) - her husband Joe (again not a real name) was walking about 15 minutes from home to go to the local coffee shop (Tim Horton's for us Canadians) where he would meet up with his chums for a morning pick-me-up. He reached the traffic light, pressed the button and when told to cross he did so. Unfortunately at the same time was a young girl who went through the (green for her) light and struck Joe. He was thrown about 15-20 feet and landed in a snow bank. EMS showed up and rushed him to the local hospital. He was stabilized and was discovered to have a massive head injury that required immediate surgery. We live in a (smallish - approx. 75, 000 pop) community that does not have a brain surgeon so he was air lifted to the closest center that could perform this - happened to be in the US. So there he went. Well his wife was notified and off she went to the US to be with her husband. She permitted them to do brain surgery and he was intubated (naturally) and was ventilated for his surgery. The surgery went according to plan and he was brought back to the ICU. He was touch and go for several days and when they tried to take him out of the medically induced coma he would not regain consciousness. He was in an actual coma. He remained this way for several weeks. When he finally DID come out of the coma he was found to have major brain trauma which stripped him of his ability to function - approx. 25% of what he was previously. It took him almost 2 years to be able to even slightly talk (remembered how to curse though which is hilarious) but he had a feeding tube and ended up also needing a catheter. He was wheelchair bound and required support 24 hours a day. He was put into a nursing home for this care but his family also provided for him additional care during the day hours so that his therapists could work with him more personally and often and TRY to regain some function. Then he started to get complications upon complications. This inevitably caused his death. During some part of this his wife was notified that she was NOT allowed to make decisions in regards to his health OR expenses because they had had NOT created a power of attorney, living will or advance directives and so someone else had to make these decisions PLUS she had to go to court in order to get these right given to her (as it should have been).

Because I've seen this and what Jane and Joe had to go through - from this side - and seeing what patients and their families have to go through when these things aren't put into place..... as well as when they are (it's wonderful when they have been). I would like to make it known what I would want or not want.... husband and I tend to disagree on some of it. He would like me to be kept alive (on a ventilator and everything else) so that he could be with me. I on the other hand would NOT want to be kept alive if I were to be incompacitated or diagnosed brain dead.

I had a conversation with my BFF about some of these things and we talked about scenarios because I told her in no uncertain terms that I would NOT want a tracheostomy. Well she made me realize that I would ONLY want it if it could come out - and I would only allow it for 30 days (ever seen the episode of Grey's anatomy - 30 days and that's all I get - if you can't figure it out by then I'm being taking off support) then take it out and if I live then i live - if not I die and I'm ok with that. Clearly I wasn't meant to live.

Now the ONLY time I want to be on a ventilator and kept alive is if I were pregnant and the fetus could be viable and NORMAL (no cerebral palsy due to hypoxemia) then keep me alive until I could "give birth" then take me off life support.

Now if I were expected to live but have some deficits - if I could be expected to be at least 75% of who I was previously (mental faculty wise) then do extradinary measures. If I need antibiotics - please give - I completely agree with them. Don't give him a G/J or any other kind of tube to extend my life. I see enough of this at work and do NOT agree with it. I WANT to be able to drink and eat the "normal" way and if I would die if I didn't have a tube going into my body then that's not the way I would want to live. Again if it's longer then 30 days - let me die! When it comes to tests - do them, do as many as you can to try to figure out what's wrong with me and try to fix it - I'm ok with that - I like tests, it makes treatment easier and WAAAY more effective. When it comes to CPR it's a bit trickier - inately I agree with CPR. However, the longer that CPR is done, the less likely it is that mental faculties will be back to 100% so really, would I want extended CPR?! I suppose I will have to ask a doctor about this to truely know what my answer is to this one. I agree 100% with dialysis and pain medication - I think these things are totally important. I can't think of other things that should be included but I will totally update these kinds of things as I learn and see more.

I think MORE people should put it in writing what they want. And try to think of ANY and ALL kinds of situations.