Monday, March 31, 2014

Never thought this would happen

Saw the surgeon today, after my night shift....

And he said that I was healed enough that he cut my fistula string!!!!!! I'm done with it.

I never thought it would happen. It's felt like it's been FOREVER and a day since this all started.

He said I don't need to see him again....

Unless I develop another abcess (good God I sure hope not!!!) or if the fistula doesn't close up properly and I am still getting discharge and pain in a month from now.

He gave me another month of short weeks for work but then I should be back to work regular schedule!

Saturday, March 29, 2014

How did I get myself into this mess?!

I was sleeping away, dreading getting out of bed.... it was after 3:30 when the phone called.... it was my charge nurse asking where I was and why I wasn't working! HOLY SHIT BATMAN, I wasn't SUPPOSED to be working.... Hell I even double checked that since two weeks ago I went into work when I wasn't supposed to be working (OK with that because at least I'm not getting in shit for going in when I'm not supposed to)... so I made for SURE what I working this weekend. So much so that I printed out new schedules last week because I was paranoid about missing a shift or something.

So I told my charge nurse that I didn't have a problem coming in but that I would also bring my schedule to PROVE that the problem wasn't me this time!!!

So I brought my schedule in and even proved myself! What was her response?! Ya, make sure that you go into the scheduling system to ensure that you know your shifts, don't go by the print outs that SHE does!!!!! Grrrrrr...... Lady it's not like I'm available to work many shifts! We also called scheduling people to ask when the shift was accepted... turns out more than a week ago at 10:20 AAAAAAAMMMMMM - let me state this in VERY clear language - I LOVE MY SLEEP!!!! So when I drop my daughter at school, I go straight to bed... I do NOT pass go.... so I sure as hell wasn't answering the phone at that hour to accept a shift more than a week in advance!!!!

Plus, when I accept a shift, I get the scheduling people to send me an email indicating which shift I've accepted on which day so that when this sort of shit happens I can have proof or something.... well I certainly did NOT have an email from them indicating the "supposed" shift I picked up.

So off I went.... late - and it was the shift from HEEEEEEEEEEELLLLLLLLLLLLLLLLLLLL - it was like it was fucking payback for not knowing I was supposed to be working or something.

Pt 1 - CVA, lang barrier - on the call bell ALLLLLLLLLLLLLL the time - which I don't understand half the time what the pt wants... so that was fun - oh and a diabetic so you have all the extra work that goes along with that.... plus she's incontinent.

Pt 2 - non formed but has a security guard - because he's hallucinating - that snakes are crawling all over him - turns out it's actually illusions which still suck majorly but the pt KNOWS that what he's experiencing isn't real but still it traumatized and wants it to end! Plus he's a double amputee who's also a diabetic - and is newly admitted and the chart hasn't been checked yet by a nurse (so that "fun" job lands on my shoulders - which has to be checked BEFORE I can do meds or diabetic stuff) - and he doesn't want to be in his bed (because he thinks that the bedding is snakes (don't blame him for that one) and so he's very anxious and needs a LOT of hand holding and reassurance.... plus psych came and saw him so I got even MORE orders (at least these should stop his illusions - we hope!)

Pt 3 - trached, MORBIDLY obese, basilar stroke (AKA VERY BAD), legally blind and because of the stroke can't talk - but she CAN hear and DOES understand - (man that would suck!) and she's in pain and for some reason thinks she's going to fall out of bed so ANY kind of movement makes her startle and drip the side rails for dear life. She's incontinent so it takes several of us to change her (which causes more work because you have to go FIND the other people to assist). Has a PEG tube which means that you have to crush the meds and dissolve them and THEN administer them.... which means lots of work. Oh the fact that there's a trach insitu means that you have to suction so there's more work for you there - I had to do so 4 times in my shift... and when you suction it has to be sterile so there's more work there. She's on 2 different antibiotics that you have to go into our med room for - so more work for that. And she's diabetic - so more work for that one.... oh and when I came on she was tachycardic at >145 bpm - but BP was JUST FINE - so I had to call the doc about that one - administer that med..... which didn't really bring the pulse down so after about 4 hours I had to call on-call doc and get ANOTHER med ordered.... and that all takes work because you have to transcribe the med, get the med co signed - then go give it..... and an hour later recheck vitals and an hour later recheck again. Good thing was was that she wasn't symptomatic - she wasn't having trouble breathing and her BP was good.... it was just that her heart was racing. The other part of lots of work has to do with her tube feeding - you have to make sure that you only put one can in at a time because this reduces reflux and the risk of aspiration (forget why but as long as it work it's cool with me!) but you have to still take the time to fiddle with the stuff... and when you give meds you have put them through that which can be a pain in the butt..... FYI pantoprazole is NOT a good med for PEGs or G/J tubes - it clogs them regardless of what you do. And I have told our pharmacist to ensure that autosubbing is done for this stupid med but I am ALWAYS the one bringing it to his attention.

Pt 4 - my ONLY independent pt - did NOT know that he had a urostomy until like 2000hrs when the daughter went looking for me because his urostomy was leaking!!! So off I went to find supplies to change it out - which THANKFULLY we actually had on unit! And of course THAT takes more time away that I just don't have.... he had an IV and two antibiotics - quite a bit of work for that one because I had to prime two lines (incompatible with each other) because he's a new patient.... Other than that he was simple! Poor guy got ignored otherwise. Such is the life though!

Ya it was nuts to say the least. I have 2 more night shifts to go for this weekend - I hope they're better than tonites shift! Though I know who'll be working with me tomorrow and when this one gal and I work together it seems like the floor goes crazy - honestly, the last time we worked we had to restrain FOUR patients, and other patient had a grand mal seizure for like 3 minutes! Insanity! So ya, it should be interesting!

Thursday, March 27, 2014

Got me my referrals

Saw my GP today - had an "episode" of anostic aphasia while in his office with him and he didn't take notice - I did but he didn't and neither did hubby for that matter. What happens most often is that I go blank when I can't find a word and sort of stutter or go "uuuuummmmm" til my brain can beat around the bush and somehow come up with the word I was looking for. But the doc was willing to take me at face value (LoVE him for this, usually when I ask for something with him - side note - he knows I'm a nurse in a hospital on neuro - so this helps - that I get what I want) and I got me a referral to my hospital's neuro clinic in which I can basically choose which doc I want - I have two that are great in my books - one looks like he should be on a soap opera (no lie!) and the other treated me when I had the meningitis and was in my hospital. So we'll see how that goes down!

I also got a referral to a gyne - need me a change out of my IUD - which my GP is bummed out for us.... he keeps pushing/encouraging us to expand.... I told him that when I'm done my RN THEN we will. But for now I need my IUD changed out so that that doesn't happen. He asked when I needed it by - which is December but I would really feel more comfortable having it done so before then because the hormones in it are sapped out more quickly when you're over weight and I am - about 60 lbs so and so this makes me a bit nervous. We don't want to be in a predicament that's for sure.

My other referral was for a dermatologist - I have super bad acne. Have since I was about 17, it just sort of snuck up on me and I got a bad case of it. It drives me bonkers. I've tried almost anything to get rid of it. The only thing that SEEEEMS to help is Accutane but let me tell you, it's tough shit! It's no joke. Gets rid of my acne while I'm on it and for a while after I'm off it but for some reason it hasn't been permanent with me - as it most often is with people. This drug is teratogenic (BAAAAAAAAAAAD news for fetuses!) and so you HAVE to sign a contract saying that you will use TWO forms of birth control while on it and do monthly pregnancy tests or else they won't/can't prescribe it for you. It also can do a number on your liver and so you have to have monthly LFTs to make sure that it isn't killing your liver too much.The last time I was on this stuff I burnt sooooooooo badly - even with a caked on layer of 8 million SPF! I burnt so bad that my skin on my HANDS peeled! It was UUUUUUBER grosse!

I also got my prescriptions refilled. This was the funniest part because when I asked for my maxeran and he only ordered 10 mg, I corrected him and said I needed 20mg he was like "what you addicted to it?!" Shit I almost pissed myself.... who was he kidding, it's not like it's addictive! I knew he was joking but still.

Then I got my sick note for work so that I can still work weekends - tho I asked for Thurs to now be included. More days available to work = more money for me!

Oh and I also went and got my criminal record check done - it'll only take 4-6 WEEKS to be returned - FUCK ME! Damn I should have gotten it done sooner cuz my community volunteer hours have to be completed by the end of april! OOOOPS, my bad!

Monday, March 24, 2014

Something's happening to me

I'm a bit in denial. Have been for quite some time. When BFF was here it struck home that it wasn't just me thinking that I was off, she noticed it as well.

For the last year I have noticed that finding the "right" word has become difficult. In the last 3 months it's become a daily struggle. I'm finding my eye sight a bit off, as well as my hearing. Oh my hearing - I feel like I'm going deaf. Hell I feel like a hypochondriac. But are you one when others start to notice these things as well? I don't know. It's been really hard writing my papers for school because I'm struggling to find the word that I want but doesn't sound right in the sentence and having to use the built in thesaurus when I already know that i should know the word but it's not coming to me is frustrating. Writing this blog is frustrating at times as well because of this. How to you relate how you feel when you can't put it into writing (let alone speaking) - let me tell ya, I certainly can empathize with my aphasic patients!

When I "googled" the difficulty finding words thing = anostic aphasia is what they call it. And it turns out that it's not so great. Options open to me are lesion, tumor, or brain injury (AKA actual injury or stroke) - so ya not good options!

I was hoping when I worked this weekend that I would come across one of our neurologists and simply ask their opinion but alas I did not. I don't work until next weekend so it's unlikely that I would come across one then anyways. So I suppose that I have to make an appointment with my GP and see what he thinks. I know something's happening to me, I just have a hard time not expecting the worst (considering what I've been going through for the last 9+ months!).

Sunday, March 23, 2014

What did I do?!

BFF went home on Thursday. Sad to see her go. I loved having her here. While she was here I got her to help dye my hair. I figured I would try out blonde again. I was one all childhood til I reached a teenager then got the brainheaded idea to dye my hair a dark brown. Well that was stupid because it never went back to the blonde. I completely regretted dying it then. I did enjoy my blonde hair. I thought it suited me. So I thought dying it back to blonde might jump start my follicles to grow my blonde hair again (wishful thinking!). Plus mama is still blonde and it suites her so I figured since we look so much alike that going blonde again would look alright. Well I seriously chose wrong! It looked AWFUL!!!!!!!!!!!! It made my acne (you would think I WAS a teen with the amount I have!) stand out more and I hated that.

So off went BFF and I to the store to choose a color that looked much better! I chose a box of a blonde with redish tones. MUCH better!!! Suites me MUCH MUCH more! I'll have to get a pic of it.

Saturday, March 15, 2014

Lots to say

I'll squeeze a few things into this post....

I cut my hair last about 2 years ago - there were two wedding scheduled and so I was told in no amount of words that I was NOT allowed to cut my hair - one wedding was my BFF's and I was her maid of honour and she wanted us to get updo's and I love her so of course I gave into her desires. The other wedding was my BIL whom I detest (loathe actually) and my MIL told me that I was not allowed to cut it and threatened to disown me (essentially) if I cut it - BOY was THAT tempting!!! But hubby begged me and so for HIM and him alone I didn't cut it. Then I entered clinical time and it's usually preferred that the hair be tied back - so I delayed and delayed and delayed... so that takes me to my next point...

I passed clinical!!! Now some may say that that isn't much of an achievement, but this is the course in which I was failed for. THIS course is the bane of my existence! My preceptor said that I did great, and that I'll make an excellent nurse (already am one btw - wasn't about to say that to her though!)

So I went and chopped all my hair off (from the middle of my back to JUST below my ears) as a present - came home and hubby was awake (surprising since he worked nights yesterday) and he was shocked but loved it. MIL started complaining (in Urdu of course) about my haircut - oh well she's not the one I'm with so that doesn't matter much. Now today I'm going to dye it (a shocking color)...

and that leads to my third point - my BFF flies in today! YAY!!!!!!!! I'm super uber excited. Her and her 5 month old daughter are coming for 5 days. I can't wait to see them! i miss BFF like crazy - we haven't been talking much since the birth of her daughter cuz she's not working and because her daughter is a morning person (yuck!) and so she now goes to bed uber early - which means when I get off work and want to chat she's not available and when she wants to talk, I'm usually sleeping so I'm not available - it's like 2 ships passing in the night. We talk now about twice a month whereas we WERE talking about 2+ times a week. I miss it and I miss her. So I'm stoked that they're coming here. I'm also going to get her to dye my hair - easy to get her to do it than for me to struggle to make sure I get everything covered properly. I'll try to post a pic...

Monday, March 10, 2014

Called it!!!

Went onto shift - mister blood everywhere FINALLY stopped bleeding from his nose - my tampons did their job thankfully!

His Hgb dropped to 77 - so he ended up needing 2 units of PRBCs - which I think it stupid because his platelets are still majorly low - so why didn't the Dr order WHOLE blood, that would have made more sense holistically. And the day nurse should have clarified the order with the Dr as well.

Day shift hung the first unit and I ended up finishing it and having to hang a second unit.

My guy slept almost my entire shift - making up for the lack of sleep he got yesterday. I felt bad for him the poor guy. He came in for something COMPLETELY unrelated and then simply falls apart at the seams. Now we're doing the job of sewing him back up - hopefully we make the seams flawless so he can go home sometime soon!

His hematuria is also improving so that was good. Less blood loss is ALWAYS a good thing!

Now I have two weeks off - my BFF is flying in Saturday and we get to be together for 5 days - YAY!!! I just have to make sure that I get enough school work accomplished so I do'nt have to worry about that while she's here.

Sunday, March 9, 2014

A side of blood plz

Came onto shift today and this is what I found:

CBI (continuous bladder infusion) that is seriously dark pink and running almost wide open
Epistaxis (bloody nose)
Leukocytosis (UBER high WBC) - as in 22 (norm = 3.5-11) - WAS at like 70!
Anemia (seriously low RBC) - as in sitting at 91 (norm= >124)
Platelets - were seriously low but I don't remember the value

Now I can handle all this - so long as my pt isn't symptomatic....

HA as if that's possible with me!

Vitals looked like this...
T - 36.3
P - 67
R - 20 & non labored
BP - 156/87
O2 - 100% on room air

Ok well all is good except that BP - so off I go to the Dr and let her know it and ask her for an antihypertensive, and get an order for a one time dose of it. I'm ok with that since I realize that his BP is elevated because his body's TRYING to compensate for the blood loss that's occuring. Give that to him at dinner time and when I do I notice that he's huffing and puffing. Off I go to get my trusty machine to find out his O2 has dropped to 94% in just 2 hours! (During that time as I was going in and out of his room he was pulling saturated kleenex packing out of his nare and blood clots to boot) Well when I saw that value I was a bit peeked - off I go to call the on-call Doc and got an order for a CBC (complete blood count) to find out what his Hgb (hemaglobin/RBC) is. Let him know I'll keep him informed....

ENT comes to the floor and puts a piece of material on the spot he thinks is causing the bleeding (personally disagreed with him because he was bleeding down the back on his throat and pulling clots out his mouth so I thought that it would be pretty high up) and he thought that that would do the trick. Well it did for about 1 hour - then it started POURING out his nose!!! Like a bloody seive! I freaked a bit inside because there wasn't anything I could do to help really.

Get the CBC result back and it's the same as in the morning so I heaved a HUGE sigh of relief because at least I wasn't giving blood on MY shift. But I called the on-call again to let him know the value but that it was POURING blood out his nose and saturating packings like crazy. He came to assess him again and this time suggested a TAMPON packing.

So that's exactly what I did. I called ER and had them send me the tampon packing and I shoved that sucker up his nose. It expanded and made his eyes water - felt bad for that part. It hurts having things shoved up your nose! Gave him some hydromorphone, let it sink in and shoved ANOTHER one up there since he was still getting clots out the back of his throat - figured that one more wouldn't hurt and might clog up enough to stop the clots going down his throat from his nose.

I'm back tomorrow, I bet he gets blood tomorrow - either on days or on my shift. Hopefully they'll do something more with his bleeding. Oh and they have NO clue why he's bleeding in his bladder and haven't scheduled any sort of test for it.

His leukocytosis bit they believe has to do with an infection of his spine so he's in an aspen collar (neck brace) which means I can't even roll this guy onto his side (sort of in the recovery position) and let the blood drain into his mouth sort of thing. Totally anxious about aspiration - had to put him in high fowlers - don't know how he's going to sleep tonight if this bleeding doesn't stop! I guess we'll see tomorrow!

Of course this isn't the only thing going on - I also had an admission, another pt was confused to the point that he forgot about his IV and got out of bed to urinate (into a urinal!) and pulled out his IV - so I had to take the time to resite that and his veins are shot so it took me even longer! Ya I didn't leave until 1:30am! ARG, oh to be back to work!!!!!!!

Wednesday, March 5, 2014

Oooops I did it again - 2 yrs running

Forgot to call Dad on his birthday. Ooops!

I remembered yesterday at 2am - obviously WAAAAY too early to wish him a happy bday.... and I was up all night doing my readings so I slept all day, which meant I didn't get up til it was too late to call - damn!

I called him this morning - caught him before he started work. Explained what I had done. He was pretty forgiving. Made a joke about it being 2 yrs in a row. Erg. I know, my bad!

Next year I'm going to have to set an alarm or something!

Tuesday, March 4, 2014

Lack of motivation to read

I've been trying all evening (at least the last 6 hours) to get my reading done - I have to take a quiz and if I don't do the reading I'll get zero - not exactly what I want.... but holy moly is the motivation crap. Normally I can put a TV show on and away I go. Ya I know I'm weird, most cannot study unless it's quiet... I'm the opposite, there must be a show on or no studying happens.

Plus the reading I have to get done is technical and boring so that decreases the motivation to complete. why must it be so dry???!!!!

I seriously need to get my butt in gear!

I'll leave you with a thing I found on facebook.... It's exactly what I feel like I do these days - not much room for much more (aside from clinical and work)