Thursday, July 30, 2015

Another down, one more closer to the goal

This week was my final week for my summer semester. I completed my leadership course - with a 99.3%!!!!

What a relief - this will give me a A+ in the course which will help bring my GPA up - because I know with the course I'm taking next will be a doozie!

My next course will be critical care and while I'm excited for it, the teacher isn't very helpful and she makes her tests/exams really difficult. So I'm certainily not looking forward to that aspect!

What I AM looking forward to is the critical care aspect - it's an area I want to focus in for my career so I'm looking forward to what this entails.

It's hard not to think that at this point next year (God willing [inshallah]) I will be taking my final course. It makes me very excited to get this done and the next chapter of my life underway. It's been such a long time coming. This time next year will mark my 15th year of trying to get my BSN - and while I've certainly not taken the direct path, at least I'm getting to my end mark.

I can't wait to prove those who thought I couldn't do it wrong - to prove that I'm resilient and can be a competent RN.

I can't wait til I'm walking across the stage to get my degree - boy will that be a day!

Tuesday, July 28, 2015

Helicopter parenting & friendship

Today was the big day - the cast is off!!!  I point blank asked the doc how long I needed to be a helicopter parent for - I think I threw him off a bit!

"I mean, how long do I need to obsess about her risk for refracturing - to monitor every little thing she does so that she doesn't do summersaults or cartwheels or pick up stuff she shouldn't be"

"oh.... two weeks"

face palm!!!

How in the WORLD am I going to parent this child ensuring that she doesn't cause damage and continues to heal for two more weeks?! It seems hopeless.

She's a daring child, often silly and ALWAYS active. Hell, that's how we're in this mess in the first place!

Oh and if THIS isn't prophetic - we were sitting in the line waiting to register for the fracture clinic to see the Doc and the woman behind us was commenting about her grandchild and how when they removed his cast that the child refractured it and had to undergo surgery to repair! Geeze! I hope like hell this doesn't happen to us!

On a completely different note....

I was talking to my fellow nursing student (4 hrs total - I killed the phone so we had to let each other go! HAHAHA) and the topics varied (as 4 hr conversations go!) and one of them happened to be about friends.... I mentioned that hubby had little to no friends and that it was difficult for me because he doesn't have anyone really that he hangs out with.

Well dont' you know, hubby announces today that we're now going out for dinner with a new "friend" of his through work and his wife. It's weird how when you put it out into the world that it answers back! So now we're going out for dinner with this new friend and his wife and their 3 children as well as taking little  tyke along for the adventure. Wish us luck!

Sunday, July 26, 2015

Another round of testing

On friday I got a message on my voicemail indicating that I was being transferred care from one specialist to a special specialist?

I guess the results have come back on the tests that the immunologist ran has returned and so he's transferring me to someone else to have "more tests run" - but I wasn't given the results.

Now I'm in the blue as to what to think.

Obviously SOMETHING has come back positive, I just have no idea what. ERG!!! I wish I could find out the results, try to look into things so that at least I'm prepared when I go and see this new physician.

When I looked at what he specializes in I have SOME sort of idea as to what I would be seeing the guy about but no definite.

Now I have to wait 2 months before I know what the results of the tests were and what the next steps are. So bloody frustrating!!!

Tuesday, July 21, 2015

All about little tyke

Today we met with her orthopedic Dr......

T - 1 wk til the cast comes off!!!

At least tentatively because it all comes down to what the next x-ray shows.

The current one shows minimal alignment - the Dr isn't concerned by this because he said that because she's young she'll set new bone to make the current bone straight and where there's a blip, her body will eventually shave it off to make that side straight.

So now the bad news with this news..... how in the WORLD am I going to ensure that this little girl does NOT put any pressure on this newly knitting bone? Because when I asked him about whether she can put pressure on it once the cast is off he said that she shouldn't for another THREE weeks..... so what do we do to ensure that she doesn't?! When I posited this question to him, he suggested a sling.... WTH is with all these physicians suggesting slings?! He KNOWS that her broken bone is due to her having the treadmill FALL on her..... so CLEARLY she's not any ordinary little girl!!!

UGH I'm so frustrated with physicians. Can they not think outside of their little box? Strategize a way that you can save me a LOT of grief and her potentially breaking this bone again!

On a separate note - the family is heading to Pakistan. Except hubby and I!

Little tyke with go along with my MIL, FIL, and two BILs - I would love to be going but I have work and school. I don't want to be delaying getting my courses done than I absolutely have to. My MIL doesn't really understand that but at least she's accepted it. At first hubby said no about little tyke going. I think he's afraid that something's going to happen to him when we aren't there. THAT I get. But she's very Pakistani (with a good mix of white girl) and she has their appearance so she'll fit in. Plus she speaks their language fluently. I think it's vital that she understands this part of her heritage and I think she's old enough (I hope) that she will remember this trip for the rest of her life.

I wish I were going but, as I told my MIL, I want to go when I can spend a good quantity of time there - like 3+ wks..... hubby and I agreed that when I'm done school that we will make our way there. Or if my BIL gets married and we go back there to do it (they'll probably find someone to pair him up with this time around) then I'll go over. But right now is just the wrong timing. At least I can send little tyke in my place who can enjoy this trip.

This has excited little tyke like crazy. Or at least my MIL is hyping up little tyke. A couple of years ago little tyke went to England and she LOVED it! I think I'm going to have a little adventurer on my hands. I hope so. I hope she learns to love adventuring the globe and going to new places. Learns to cope with the anxiety of entering new places and doing new things. Maybe she's a globe trotter in the making! Perhaps she'll learn to see the world as a whole and not just her little part of the world. I hope that by letting her experience this at such a young age she will grow a little bit each time.

So to this I say bonvoyage little tyke, bring me back a token of your travels!

Tuesday, July 14, 2015

Creutzfeldt-Jakob Disease (CJD)

We had someone who was suspected of having this disease - my knowledge isn't the best but I knew that it could be transmitted to others.... here's what the NIH says....

There are three major categories of CJD:
  • In sporadic CJD, the disease appears even though the person has no known risk factors for the disease. This is by far the most common type of CJD and accounts for at least 85 percent of cases.
  • In hereditary CJD, the person has a family history of the disease and/or tests positive for a genetic mutation associated with CJD. About 5 to 10 percent of cases of CJD in the United States are hereditary.
  • In acquired CJD, the disease is transmitted by exposure to brain or nervous system tissue, usually through certain medical procedures. There is no evidence that CJD is contagious through casual contact with a CJD patient. Since CJD was first described in 1920, fewer than 1 percent of cases have been acquired CJD.
No idea which category this patient had but still.... it's a prion disease that can be transmitted to others and that's what's important! Infection control wanted us to isolate the patient and maintain precautions - whatever that meant! No one told us a thing, just simply wrote an order and left!

Forward 3 hours later and the nurse was checking charts and found this order. Not knowing what to do she contacted infection control who took over an hour to call back and being told that it would be important to isolate and that for any invasive procedures that items had to be incinerated and not simply put into the garbage can OR the sharps container (even though it's a biohazard container).

Now that last bit became REAL important when at the end of shift the code button goes off on the unit and you wait a minute to see if it's real or not - and you make your way to the room to find out that the code is real - then you learn it's the patient with CJD!!!

So then when ppl come running with the code cart and you get all the personnel that need to be there for a code, you have to attempt to tell them all that they need serious PPD - so out everyone runs to get covered up and I go running to get N95 masks because who knows what you're going to be exposed to!

The code is finished and patient is determined to be deceased after several rounds of CPR and epi - so then we contact infection control to find out what to do with all this "stuff" left over and what is required for the body - and we all ask each other - is this a coroner's case - is it a mandatory autopsy?

NOPE! Not a mandatory autopsy - coroner says it's up to family to decide!

HOWEVER - dealing with the body is done differently - I get told by infection control that we need to use an EBOLA body bag!!! WOW! Wasn't expecting that. Didn't even know how to go about getting that! Thankfully infection control says that the ER has it and they can provide it. Whew, what a relief!

Then we work frantically to try to clean up the mess that's left after a code because ALL PPE was piled atop the patient and that simply would NOT be good when the family came and would see this person with "trash" (essentially) piled on top.... but we couldn't just put it in the corner or in the regular garbage. So we called housekeeping and STATed the "special" bags - which thankfully they did.

Sunday, July 12, 2015

What a coming-back shift

Dealing with patient's is one thing, dealing with family members is another!

Today was my first day back from having 2+ wks off - having vacation and dealing with a nasty head cold to finally feeling well enough to take care of patients and boy was it a shift.

TWO hours in and my pt was crazily delerious and thinking that birds were in the hospital and we just HAD to "deal with the birds", "the birds, the birds, they're everywhere" - which if I were him, I would be QUITE agitated. So I get it - BUT, when the daughter gets involved and become agitated that I am not doing something to "make him better" - Lady, I've only been with him for TWO hours - I know VERY little about him - just what I got from report and from his history.

So there I am trying to calm both pt AND daughter down - bloody hell, how did this happen to me?!

So off I go to call the MRP to ask for resperidone to manage the hallucinations - nope - he says that he gave orders earlier in the day to the nurse for seroquel and haldol and for me to give this.... ok so off I go to find these "orders" that I knew little about because the day nurse hadn't updated me on these - instead leaving me in the dark!

K so I pull the meds from my pyxis - and fail miserably attempt to give these oral meds - but by this point the pt is so agitated that he is suspicious of what I'm offering.... I attempt several times with different ways to get him to take with no results - dinner comes - and he won't touch it.

That was the last straw for the daughter - she starts cussing at me saying that no one is doing anything to help her father and that he just keeps going down hill. I try to calm her down but that does nothing and starts raising her voice - that's it - straw breaks the camel's back and I inform her that if she doesn't calm the f*ck down that I would notify security (whom is already in the room with another pt) to have her excorted out of the hospital if she can't be respectful. This doesn't deter her and she continues on about how she wants an umbudsman - I inform her that I can get the number if that's what she wants - she confirms this so off I go. I also give the go ahead to the security in the room to notify main security to send someone for back up - and I go get the # as well as notify the MRP about this situation. So by the time I go back to the room the security shows up and informs her that she's a visitor and that if she can't be respectful then she can be escorted out of the hospital. She becomes quite upset and is incredulous about the fact that I gave the go-ahead for security to come.

MRP was irritated that he needed to come speak to this daughter (he said he already spent an hour earlier in the day speaking to her about everything so couldn't understand why she was freaking out now) - and once he showed up she was COMPLETELY calm - and for some reason the pt completly relaxed with him around - enough so that I could get the haldol on board and he talked to the daughter while we were waiting for the haldol to kick in - once that starts to take hold, he allows the doctor to give him the seroquel and clonazepam but won't let me do anything. ERG!!! Well at least he took them! Two hours later he's FINALLY asleep in his bed - may he remain that way the rest of my shift!

Then while all this is happening I have another pt who had IV fluids and IV antibiotics ordered and hasn't had an IV access since nights and the day shift nurse is a tard and ALWAYS leaves stuff (especially the more difficult and time intensive things) for the next nurse - not ONCE did she inform the MRP that there was no IV access!!! Instead she tried to get it, then had a NEW nurse attempt (who is notorious for sucking at IV initiation!) but not ONCE did she contact ICU who have support nurses who attempt difficult IV starts or ICU stepdown to see if they could start it. ARGGGG. So now this responsibility is mine - so I attempt - I could find it but once you start it blows or won't thread.... ARG!!!! So off I go and call ICU (like you should!) as the one senior nurse on our unit who is good at IV initiation said she was "too busy" to try.... so I had to wait for ICU to come.... which they did about an hour after calling - and they get it in the AC but kink the catheter so it's difficult to use.... soooooo I was only able to get the IV antibiotic in and then it went interstitial. So by this point it's after 1930 - which means new nurses!!! So I called ICU and asked that once report is given could they send someone for this guy..... so about another hour goes by and someone comes and attempts 3 times with them blowing each time.... ARGGGG!!!! OK, I'm done..... so by this point this poor pt has been poked NINE times!!! I assessed his feet and they actually look like they're possible - but it requires a physician's order to do. BUT of course SOMETHING gets in the way.... a code blue on the unit next door so off goes the doc to deal with that!

By the time he gets back to our unit it's 2245hrs!!!! I tell him the situation - either a foot IV initiation so that he could get IV fluids, antibiotics and hydrocortisone (steroids) - OR give me an order for these things to be oral.... thankfully this pt was drinking and eating well so while the IV fluids would be helpful it's not URGENT or emergent for IV fluids to be required. Also, the pt wasn't septic so oral antibiotics should be alright til they figure out the IV situation - this pt TOTALLY needs a PICC line!!!! Perhaps I'll tell the MRP to order one for this pt!

Then you have 3 other pt's with required needs, as well as another pt who had diarrhea who required bedpanning four times in my shift as well as a blood product and several nebulizers. Ugh it's just too much for one person and there's no one that I could delegate to :(  Hopefully my next shifts are better!!!

Wednesday, July 8, 2015

Getting to see big one graduate, seeing family, relaxing and healing

Went to hometown to see big boy graduate from grade 8 - he won THREE awards - including geography which was a total surprise to both him and I! He got one for participating in this math contest where he does university level math - he didn't win from his school but did pretty damn well. For his math course he got 95% on the province wide math test that they give the kids - so ya, I have a little smart E pants on my hands! In his yearbook he said that his goal is to "become an orthopedic surgeon" - if he keeps his head in the game then it's possible. The last time we talked about his goals he talked about how he wanted to get his degree in science then go on to med school.... I cautioned him against this because my hubby's in the boat of getting his degree in biology/chemistry (so a science degree) and not being able to find a quality job (has one now but it took a LONG time) - so I told him that a better bet would to get a BSN - a degree in nursing - because at least that way he's getting experience in the health care field - he's getting knowledge of diseases/conditions,etc... as well as medications - he'll get experience dealing with patients, as well as families - and once he's done the degree he can work PT/casual which in med school or while awaiting med school entrance - I mean who wouldn't rather work for $25+ vs. minimum wage ($10) - and the kid actually heeded my advice and has since decided that he's working towards nursing school then to med school - little does he know that the one med school we have in the province here accepts nursing students who finish their 3rd year.... I think that would excite him.

Amazing how he's only 13.5 yrs old and he's already taller than me and I have heels on!

So after the graduation we spent the rest of the week out at the cottage - and it was glorious.... not really weather wise. I think for the 8 days that we were there we saw 2 truely nice days where it made me hot enough to want to jump in the water! We had fun though, and it was a nice change of pace and allowed me to decompress a bit from school work - I did very very little while I was away.

My mom really did something real wrong.... for 7 years now we've made it a rule that little and big kid do NOT eat pork - when big kid doesn't reside with me I can't control what goes in his mouth and his father wouldn't follow my rules even if I stated this needed to be followed.... but when big kid is in my possession or in my parents, I expect this ONE rule to be followed. I know how much everyone in my family loves pork products so I ensure that when I visit that I am providing non pork options that won't leave someone jonesing for the pork product. I ensured that I had sausage that tasted just like it and turkey bacon that legitimately tasted yummy (It was maple smoked turkey bacon to be specific) as well as morning turkey breakfast sausage patties.

Everything was going great until the last breakfast that we had together - we invited everyone out for a brunch and my  mother decided that she just **had** to make spam - my son's favorite meat (why is beyond me - bacon rules in my mind!) - this year I didn't bring any non pork spam (I have previous years) and so I told my mom in NO uncertain terms that my son was not to have ANY - not a single piece - yep, my mom said,... sure, no prob.... and I got busy making pancakes, turkey bacon and turkey sausage patties - and then my hubby over heard my mom say to my son "take this for you to eat later" - spam is what she was telling him to save for later. UGH!!!! But hubby didn't tell me about this encounter until almost midnight when my mom was already in bed and we were playing cards with my aunt and son  - so I was big time pissed with my son because it sounded like he ate it - we took a break while fireworks went off and I was fuming and had gone into the cottage to cool off and low and behold my mom comes out of her room to go to the bathroom - I told her to "hold up a min, we need to talk" which she did to hear me out and then said it was all my son and she didn't do that.... so off I go to clarify with my son and my husband who BOTH said (son first and hubby verified) that it was my MOTHER who gave the meat to my son. So ya, I was furious! We only have ONE rule that is NON negotiable! The next morning (day we were leaving) it was soooooooo silent - you could literally FEEL the elephant in the room. I got things packed away and then mom and son went outside and were sitting down so I went out there to get it over with - when I broached the subject I just said that I was drastically disappointed with their behavior and that they BOTH disrespected me - that I provided options that made it so that little boy wouldn't feel deprived not eating the pork products and here is my mom GIVING it to him. My mom just walked away from me. I couldn't believe it.

Another crazy thing happened while we were there - the entire week we were super careful with little tyke about keeping her feet on the ground and being careful with jumping and being around the dogs and such. About the 3rd day we allowed her to play in the "park" (on the swing set with a slide) - and we were CONSTANTLY screaming reminding her that she needed to be extra careful on the swing and NOT to be silly!!! Well she was good so we eased off on the screaming reminding her and thennnnnnnnnnn................................ ****BAAAAMMMMM**** she falls on her BROKEN arm!!! And starts screaming about how much it hurts, and she can't move it again - goodness!!! Hubby wanted to bring her straight to the hospital but I told him to just wait for a big and see how things go - thankfully a couple of hours she was using just as before the fall and said that the pain was less. So hubby said he wanted to wait til the next day to go to get an x-ray - before we headed home. Well the next day it was like the fall hadn't happened so hubby and I held off and we got an x-ray when we got back home.... hubby took her as I had to head off to work - he said it looked the same so I relaxed a bit.

So a couple of days ago we had a follow up with the ortho doc and got new x-rays - see below....

Thankfully she's healing and setting new bone down - on the left one you can see the bump on the right side of the broken humerus which the doc says is new bone forming and on the right photo it shows where on the left side of the humerus that the bones are beginning to knit together - all of which is good news - doc said that she may only need the cast for 2 more weeks but that her next x-rays will determine if it will be for longer. Time will tell!!!