[Gennaver]

Hi,

Boy am I glad to find this forum! I went on an interview last friday at a very well reknown local hospital and was given the unofficial 'you are hired' as a student nurse extern by the manager of the oncology/hematology floor. So, yeah, I was very thrilled.

The recruiter was wonderful and I sent her a letter of thank you. I included a question for my new manager if anyone would be willing to not only let me have the agreed upon, one-on-one single shadow shift a week, (versus cna work the other days) but if I could possibly conduct a research project.

My interest is Psycho neuro immunology. I am a masters entry student with off an on over 15 years of cna experience, (several hospitals). I waited for the official call saying I had the job and when it didn't come I sent an email.

Thank goodness the recruiter is so kind, she said to please disregard the letter of rejection that may have accidentally been sent because she and the nurse manager decided that maybe the oncology/hematology might not be were I belong, (well, okay but, I feel that there is really no area in a hospital that I would 'not' take). Turns out that they are going to petition the Neuro ICU or Neuroscience floors to see if they will take a student nurse extern, but, that it might not be in their budget.

Argh, how anguishing?

Anyhow, my undergrad is in Sociology and Psychology and I have an Associates in Biology and I really thought that in order to do my research in PNI that I would need patients who have all of their mental capacities, (not neuro patients). I was hoping to study how their emotions and state of mind affect their immunity and recovery. So, I figure that the nurse manager on the oncology floor may not really understand what PNI is OR she and the Nurse recruiter, (I feel like she is totally on my side) really have a fantastic handle on staff and can tell that my future interst in going for the PhD may be better served by me and them, in Neuro.

Yet, I would be very stoked to get into Neuro also because for the last 10 years I have been fascinated by cognitive ability based on neural function and also in the minimal new neural growth which does happen slowly over the years and also in the increase in neural ability after intense brain perfusion, (such as running long distance causes.)

Well, this was a long and varied post, any advice or recommendations is helpful.

Gen

[Tweety]

Congrats on the job Gen. Good luck to you in all that you do.

[Gennaver]

Originally Posted by Tweety

Congrats on the job Gen. Good luck to you in all that you do.

Thank you Tweety!

My fingers are crossed until it becomes official. Hopefully by early next week. I am still thrilled, (anxiously waiting for confirmation).

If it ends up outside of the budget I am going to ask the nurse recruiter if I can work as a regular CNA rather than an extern. Since they have all my documentation and letters of recommendation and the interview is behind us and all, I would hate to pass it up.

Gen

[Gennaver]

Hi again,

Rather than start a new thread here I figured I would add my novice questions to this thread.

I was reading around here last night and came across several posts that mentioned the head breath, (I have encountered this too, while working in physical rehab with TBI patients, I never thought about where they were before they came to us but, it must have been neuro )

It dawned on me now, that it must not be the oral problem of breath but, from metabolic processes from the body trying to get sufficient glucose for the brain. The breakdown of fats and proteins right? Ketoacidosis.

Is this one of the symptoms to go along with insufficient carbohydrates, (glucose) or am I way too much of a newbie to get it? Does this symptom signal a blood glucose test or for an A1c? Is glucagon administered? Yes, I will also read around to find out how such patients have perfusion encouraged too.

I promise though to do the oral care regardless of the cause of the brain injury breath!

Genn

[1Tulip]

Dear Gennaver,

I don't know exactly what "head breath" is. The term is new to me. But I worked ICU for a long time and I think any patient who is obtunded and can't manage their secretions, who can't swallow and is NPO... absent meticulous oral hygiene... will have encrusted mucous membranes and teeth. Comatose or delerious patients (covers a lot of neuro) don't open their mouths for easy nursing access and may actually clench their teeth closed in reflex. Add to that the fact that some "oral care" products are hyperosmotic and contribute to descication of the membranes of the mouth, and you probably have a vile enough condition to refer to as "head breath".

Having said that, I do not believe any patient should have less attention to their mouths than we give our own. There is a way to gently open a patient's mouth and keep it open (I use tongue blades in a trick I learned from an anesthesiologist and can describe if there is interest) after which water, mouth wash, tooth brush, elbow grease and a suction catheter can be put to effective use.

If there are metabolic conditions that make the patient's mouth more vulnerable, it just means they need to have their teeth BRUSHED more frequently.

I'm not sure what "head breath" is, but I'm willing to bet it's preventable.

[Gennaver]

Originally Posted by 1Tulip

Dear Gennaver,

I don't know exactly what "head breath" is. The term is new to me.

... There is a way to gently open a patient's mouth and keep it open (I use tongue blades in a trick I learned from an anesthesiologist and can describe if there is interest) after which water, mouth wash, tooth brush, elbow grease and a suction catheter can be put to effective use.

.....

I'm not sure what "head breath" is, but I'm willing to bet it's preventable.

Hi 1Tulip,

Not sure about the term myself, read it here, (in another thread).

Yes, it would be kind of you to share the gentle maneuver to open a patients mouth!

I concur on compassion, as I would assume that the nurses who jokingly used the term 'head breath' do as well.

The thread that I read it in was an obvious gallows humor type of thread. It would be unfair for you to not know that.

Thank you,
Gennaver

[papawjohn]

Gently opening neuro pts mouth....

Hey Y'all

I'll speak up for Tulip, since she's gone off-topic for now. I bet we do this the same way.

First, grab the oral cleaning supplies. One way I do it is by combining (in a specimen cup or similar) 1/3d Saline, 1/3d Peroxide, 1/3d mouth wash, toothettes, small (tracheal) suction catheter. And about 12 or 15 tongue blades.

Then put two of the tongue blades together and put that 'sandwich' between the Pt's teeth. Then slip a third t-blade between them. Then a fourth, a fifth, a sixth, etc, until your Pts mouth is sufficiently open to do oral care. Also works for moving and retaping ETTubes, placing OG tubes, etc. No one has ever been able to keep their mouth closed in my career, if I could get those first two tongue depressors between their teeth. And since the t-blades are quite soft wood--no one has ever been injured.

Papaw John

[1Tulip]

Exactly PaPaw John. And here I thought I had this really cool secret technique!

There seems to always be just a little bit of malocclussion in the front where you can slip the first two tongue blades in.

I would add that I try to maneuver my stack of blades back between the molars if I can.

[Gennaver]

Originally Posted by 1Tulip

Exactly PaPaw John. And here I thought I had this really cool secret technique!

There seems to always be just a little bit of malocclussion in the front where you can slip the first two tongue blades in.

I would add that I try to maneuver my stack of blades back between the molars if I can.

Hi to Papaw and 1Tulip,

Great way to do this! Thank you for sharing. I really like the 'no impact' factor and safety of soft wood.

Gen