Thursday, February 26, 2009

The Frozen Northlands

I leave today, after my second midterm for The Frozen Northlands. Sometimes there is internet access in the Northlands, sometimes not. But we do have snow. Lots and lots and LOTS of snow.

I won't be doing any nursing stuff for the next week or so though, so the chances of any interesting blog entries is somewhat lessened.

Happy "Spring" Break! (there are no leaves on trees, no green grass, no flowers, and at home there's 3 feet of snow. It's not spring.)

Just remember kids: YOU CAN'T SHOCK ASYSTOLE!!

Wednesday, February 25, 2009

Nephro: An Introduction

Today's pt. was NOT cardiac, though he'd had the obligatory CABG some years ago. He has had prostate and bladder cancer, and a resected bowel, and god knows what else. He was on our floor because...well...I'm not really sure. Medical floor overflow I suppose. CHARMING man, he was really fantastic, great storyteller.

The Interesting Part: He had a nephrostomy. It LOOKS like a colostomy- pink stoma, bag attached, but instead of draining feces, it drains urine, directly from the ureter, because his bladder was obstructed by tumor, and removed. Two days ago they added a shunt to ANOTHER bag, draining his kidney directly because of an infection. Kind of painful looking, actually, and draining bloody, cloudy stuff. He didn't wince when I did the dressing changes, LOVED having a student, and regaled me with stories of the old WW2 comics he used to read, about brave army medics and pretty nurses. He agrees that the cape SHOULD make a comeback.

Also got to hang out with the telemetry techs again, and learned the finer points of paced rhythms, so I no longer look at them and say "uh oh! wide complexes! DANGER!!"

Tuesday, February 24, 2009

I am NOT poison control!

But nevertheless, a friend from college just called to ask if swallowing a bottle of codeine syrup would kill/ seriously maim you. Some chick she knows just did it.

Me:"Call the ER, and ask them if they want you to bring her in, or just give her ipecac"

Her, 5 minutes later: "Ok. ER says ipecac. And I dont even LIKE this chick!"

Better her than me...I wouldn't have gone over there when she called to say she'd taken it, I'd have just sent 911 over there to haul her to the psych ward.

Monday, February 23, 2009

I Spied Three Things

Three things I've never seen before while doing an observation day with the Wound Care Nurse, all of them vaguely horrifying.

1. The fattest man I have ever seen. I'm not prejudiced against large people, but this guy weighed in, on admission yesterday, at 904 pounds. Yes, NINE HUNDRED AND FOUR. He is scheduled to have some sort of pannus-removal surgery. The docs are pretty sure he has a heart condition, but he's too big for ANY nuclear medicine studies (the tables aren't big enough, and he wouldn't fit inside the machine, and too big for the cath table, the OR table, and pretty much everywhere else. They're planning to do the surgery IN HIS HOSPITAL BED because they can't move him. It took 7 of us to roll him to assess his skin integrity.

2. Somebody's tendon. No, not in surgery, he had a pressure ulcer from where another hospital put pressure ulcer preventing (o irony) boots on him. The inside of said boots were hard plastic, so the skin over his achilles tendon broke down. Voila! Tendon! He was really out of it, and on a vent, but it was still horrifying. I mean, insides are supposed to be on the INSIDE. Also, his big toe was BLACK and about to fall off. I don't think he'll be walking again.

On the other hand, I doubt he's going to be CONSCIOUS ever again either. Sad, either way. He just took really lousy care of himself (smoker, alcoholic, morbidly obese, no exercise, diabetic, dialated cardiomyopathy, cardiogenic shock, etc.)

3. A wound-vac. They're gross. I'm sorry, but I don't know how the floor nurses can deal with that. I mean draining normal stuff like blood or serum? Fine. This was draining...infectious goo. NOT fine. Gross.
And she had the inevitable NON EXISTANT pain tolerance. She screamed when the nurse POINTED at her, and demanded more "mo'phine", because we were "torturing" her. Without touching her. When she said she was comfortable when we walked into the room. Oy.

Sunday, February 22, 2009

Care plans suck

They really do. It takes me forever to write it all out, and I can rattle it off verbally in about a minute and a half.

Fortunately, my clinical instructor thinks they're annoying too. She MAKES us do verbal care plans on every patient every day. Which is BRILLIANT. She has a formula for it too: First start with all the assessments you need to make, then all the labs you would check, then all the interventions you can do WITHOUT calling ANYBODY, then the interventions you can do WITH other services (pt, ot, nutrition, et cet) THEN the medications, THEN things you have to call the docs for.

She says that this way we'll get into the habit of always looking for our independent actions FIRST, and in many cases we won't HAVE to wake a doctor up, which will make EVERYONE happier.

Have I mentioned that my clinical instructor rocks? She still works PRN on the floor where she teaches, and knows EVERYONE. This floor is awesome, and the aides kick some major ass.

Wednesday, February 18, 2009



Specifically, I managed to at least land an interview for Children's Hospital of Pennsylvania's summer externship program. My first choice of placement? ER of course. If i can learn to put an IV in a tiny little arm, I can sure as hell put one in a BIG arm.

Fingers crossed that I get a spot!!!

Comprehensive Care Plan

Today was our designated day to create a "comprehensive care plan" for any patient on the tele floor. I picked a sweet LOL going in for a mitral valve replacement tomorrow. She let me do a complete workup on her, including history, complete physical exam, patient teaching, nursing diagnoses, et cetera. She said that she was "bored, so why the heck not!?" I love patients like that. You get to learn SO much from them.

I even got to do something helpful for her- I was with her in the Echo lab when her REAL nurse called in- her APTT was over 150, meaning DISCONTINUE THE HEPARIN!!! IN A HURRY! So I did so, and felt, for about a tenth of a second, like a Real Nurse. Then it passed.

We've started learning about EKG interpretation in class, which is totally and completely awesome. I used to be able to only read Very Bad Things, like Torsades des pointes, v-fib, v-tach, and of course, asystole. Now I can read PVCs, a very few kinds of bundle branch blocks (assuming NO other complicating factors), and junctional rhythms. Very Very Cool.

What I DONT understand is one of my fellow students. I asked the professor if I could go hang out in the telemetry room once all my charting was done, and before she could answer, Fellow Student says "WHY would you want to do THAT?"
Me:"Um...because they show you lots of neat things about cardiac rhythms"
FellowStudent: "Who CARES? Its not on the TEST!!!"

It boggles the mind. I want to know, because i DONT KNOW IT. That's actually reason enough for me to want to learn about it, setting aside altogether the fact that I want to work in an ER, and they dont HAVE telemetry techs to read all the monitors down there. Grrr. She has NO curiosity whatsoever. And she's lazy. I wouldn't want her taking care of ME.

Monday, February 16, 2009

How To Look Pretty For Clinical

It isn't easy, I'll tell you that. Nobody really looks their best rolling out of bed at 5 AM, pulling on our godawful uniform, and hightailing it to the hospital, but I do make an effort. I'm vain, and I'm single, and dammit I want to look my best, insofar as it is possible. It doesn't help that I have a DIFFICULT skintone. I am SERIOUSLY pale (like, porcelain pale) but without pink undertones in my skin. I'm the world's palest olive tone, the sort that LITERALLY turn green when they're sick. You can see most of my veins through my skin.

On the other hand, you do NOT want to be that girl who shows up with a ton of makeup on- you'll look silly, and you probably did your makeup under different lighting. Hospital lighting is NOT forgiving of makeup errors. There is a girl in my clinical group who seems to think that she cannot go out without bronzer. You can TELL. She looks muddy.

On that note, here's what I've found can be done in a relative haze, and still make you look human without making it obvious that you're wearing makeup.

1. MOISTURIZE. Hospitals are dry, you will be dry, invest in some good moisturizer with an SPF (for when you DO go outside), use it liberally.

2. CONCEALER, for spottiness. Make sure you test it on yourself in NATURAL light, AND under nasty halogens. This will help prevent it suddenly becoming scarily visible at the hospital, and ruining all your work.

3. FOUNDATION- if you wear it, wear as little as possible, mix it with moisturizer, and for God's sake, make damn sure it really matches your skintone.

4. BLUSH!!!!! I cannot stress how much I love blush. I recommend a very light pink for people as pale as me. Something NATURAL looking. Brush it with a really big brush over the apples of your cheeks, then dust a TINY bit on your chin and brow bones. This part might not be necessary for people who actually have color in their skin, but I find it does WONDERS for me. Makes me look human, refreshed, happy. It is also far easier to use than bronzer. DO NOT USE BRONZER. It doesn't look right under hospital lights, I don't know why. Blush is much more forgiving, and gives you color without that "i swear i was just in cancun" fakeness.

5. MASCARA- if you can use it this early in the morning. I usually go for a brown color, and use just one coat of something that will not clump. Rimmel is good. It opens up your eyes, helping you look alert.

6. Clear Eyes solution. Seriously. If you were up late writing your care plan, use this so your patient's dont know.

And that's basically my morning routine, give or take a few products depending on how alert I am. I can't help my uniform, but dammit at least I look awake!

Short post

I am spectacularly unmotivated today, and have the day off from clinical due to my instructor not having a babysitter for President's Day. I think I'll go to the gym so I don't sit around doing NOTHING.

Also, I should finish this care plan on pain.

Sunday, February 15, 2009

The Drunkest Guy Yet

Last night was an interesting shift. 18 hours, two calls, which isn't bad. The first one was no big deal, (moderate concussion, easy transport, cooperative patient).
The SECOND patient was a whole different story. 3 am is never a good time to be hauled out of bed, and we knew it wasn't going to be an easy call when we could smell the alcohol from OUTSIDE the room. The patient was (sorta) conscious, but he thought it was Halloween, he kept giggling, and he repeatedly climbed out of the stairchair because "seatbelts dont belong on chairs!!!" He hadn't vomited at all, which was a blessing from a messiness standpoint, but I have no idea how he managed to drink so much and not get sick. His friends estimated that he'd had 10-15 shots in the preceeding hour, and must have JUST stopped drinking before the campus cops found him.
Once on the ambulance, he repeatedly attempted to grab my breasts while I took his blood pressure. Who knew that "no, these aren't for you" actually WORKS as a deterrant? Then he passed out, which made things easier.
Hope he's ok...KNOW he won't know better.

Friday, February 13, 2009


I would just like to state, for the record, that hyacinths smell AMAZING...and that I got some at Trader Joes for 2 bucks. WHEEEEE!!!

Wednesday, February 11, 2009

Unexpectedly Emergent

Today I had a lovely pt. on contact precautions for MRSA colonization (no active infection), and got to follow her to the lab where they were testing her brand new internal defibrillator. What this involves is quite nerve-wracking. They sedate the patient, pace her on the T-wave, which sends her into V-fib, and then WAIT and see if the defibrillator can kick her back out of it into sinus. This was the SECOND test. The day before the test had failed, and they had to use the external paddles. This time, after ten heart-stopping seconds, she cardioverted, and all was well.
The second drama in the day unfolded about 4 minutes after I left the lab: one of my classmates came running up to say that a girl in my carpool had collapsed in the hallway, unconsious, and was being taken to the ER. Needless to say, the two of us in the carpool with her ran down to the ER, and stayed there until her discharge 4 hours later. Diagnosis? Vaso-vagal syncopy, with mild bump on the head. Basically, she stood still in a freezing room for four hours, and hadn't eaten in 6. When she walked OUT of the cath lab into the hallway, which was VERY warm, and her blood started moving again, she passed out and bumped her head. All is well, but it made for QUITE an exciting day. The best part was taking the EKG electrodes off her every 20 minutes so that she could go to the bathroom, because they had her IV running in so fast.

Monday, February 9, 2009


Today I was sent to "observe" in the Short Procedure Unit. In other hospitals this is known as the "Same Day Surgery" unit. We (me and my counterpart from the other clinical group) spent most of the morning in the Intake part of the unit, bringing patients back, orienting them to the unit, helping get them into surgical gowns, caps, sock-with-treads, et cet, then taking vital signs, and completing intake assessments. We were only TECHNICALLY supposed to be OBSERVERS, but the nurses were busy, and pretty soon we were doing 2/3 of the intakes, while the nurses were doing the urine pregnancy tests, starting IVs, giving meds, and charting. This was fine with us, as we had something to do.
The remainder of the day we went to the POST surgical area, which is also known as Recovery II. Recovery I is the PACU, where patients are brought out of anesthesia, and vitals are assured to be stable. If the patient is going to be staying, they then are admitted to a floor. If, however, they've had a tonsillectomy, or a tendon surgery, or a fixation of a broken arm, or something, often they come back down to the SPU, and stay there until they are ok to leave- not nauseous, fully consious, pain controlled, feeling ok. We helped dress people, complete "discharge teaching", brought warm blankets and snacks, and basically did all those little things that are really nice, but nobody ever gets time to do for the patients. We got profusely thanked about 40 times.
If only our patients up on the Cardiology unit would be so grateful... :-p

Wednesday, February 4, 2009


Spent last night helping at a clinic downtown for non-English speakers. Our responsibilities included doing all of the vital signs and "triage" to ready patients for their appointments, and we also got to go in with the nurse practitioners and see what THEY did. The hands-down coolest part of the evening was when we got to watch the doc on duty do an ultrasound on a patient's thyroid. The patient had a VERY large goiter, something I've never seen before, with necrosis and some liquefaction in the center. The doc walked us through everything he was doing, all the abnormalities. I'm not sure this was for OUR sake, or for the sake of the two COMPLETELY USELESS medical students. They didn't know ANY anatomy, and just stood there like idiots.
It was pretty great, altogether.

Monday, February 2, 2009


Echocardiograms are COOL. I just had to say it. I dropped my detoxing patient off for his Echo, and the tech invited me to stay, and showed me what all of the views were for, what to look for in the heart, and even gave me memorization techniques for visualizing cardiac anatomy. This came in REALLY handy when I was able to inform the doc that there had been abnormal findings in the Echo consistant with amyloidosis. As this was an incidental finding, not something they were looking for, I was worried that it would fall through the cracks.
Not that it would matter to my patient, on his latest of many strokes brought on by completely uncontrolled HTN, seizures, and cocaine use. He HAS insurance, but he chooses not to purchase his meds, as the 4 dollar scrip cost would cut into his cocaine budget.
And he smelled like a sewer, and refused my repeated attempts to clean him up. Honestly, I was going to be nice, and clean him, but Noooooo. That was just NOT cool with him. Instead, he wanted a second lunch, so that his wife could eat too, without buying food for herself. "nope!" i said, gave him a sub-Q injection, and left the room. With the side rail up, call bell within reach, like a good nursing student.

Sunday, February 1, 2009


Sometimes being an observer sucks. Three calls last night, ALL of them intoxicated underaged idiots. Honestly, I'd like to do a presentation to the freshmen at Orientation entitled "Please stop before you vomit: how to not be a tool when you drink". Or, if that's just TOO MUCH TO ASK, I wish they'd start drinking at 3 or 4 pm, so that the calls to evaluate drunken kids would come in at 10 pm instead of 3 am when we're all tucked into bed at the squadroom.
One interesting fact is that the reaction to being caught usually falls out along gender lines: the girls are the ones who inevitably start sobbing, say their parents will be SO MAD, and slur incoherent questions about whether they're "going to get in trouble". Sweetie, you were in trouble BEFORE we got here. Yes, you ARE going to get written up if you're so drunk they called us. Its not like the campus cops are TRYING to get these kids in trouble. If they "catch" somebody, it's usually because theyre falling all over the pavement.
As a result of this terribly unsatisfying drunkenness, no trauma, and i barely slept.