sunkissed75 5,385 Views
I run for chocolate
complex regional pain syndrome (crps, formerly called reflex sympathetic dystrophy) starts with a tissue-damage injury (even an mi can cause this but it's more often some sort of ortho or soft-tissue damage). for reasons that aren't exactly clear, the pain pathways in the brain don't get the message that the tissue damage is healed and they keep on reporting pain, pain, pain to the cognitive part of the brain. it is worse with depression, because those parts of the brain are right next door to the parts that assign meaning to pain; and constant pain is depressing, and it gets to be a vicious circle. the pain is very real, can be excruciating, and can spread to non-injured areas as newer areas of the brain take up the cause. it's a horrible disease, because there are no physical symptoms and sufferers can be mocked, penalized, stigmatized, and have their pain rating arbitrarily downgraded because nobody believes them. they may be sipping their lattes or sleeping (often from exhaustion) but that does not mean they don't have huge pain. people can adjust to anything, and this is sometimes mistaken for fakery.
the treatment is normally meds that work on neuropathic pain, e.g., anticonvulsants and other neuropathic meds. opioids/narcotics are not effective for crps. if someone is taking opioids for chronic pain and they are not helping, opioids should be tapered and withdrawn under medical supervision while more effective meds are trialled. this is a very scary time for patients; suicides from chronic pain are not uncommon. some less-well-established regimens (iv ketamine is one) can be helpful but are not always paid by insurance as they are rated experimental.
whatever the cause and treatment, it's well established that psychotherapy to help with reframing pain perception and dealing with the depression is a vital, non-negotiable component of chronic pain management. insurance carriers are often loath to approve it because they are afraid they'll be paying for it forever. they might, but if the person becomes more functional as a consequence, it's unconscionable to withhold it. physical therapy and regular activity in spite of the pain is also helpful in reducing pain over time. seems contradictory, but it works on the brain's centers for pain sensation and cognition. people can get to the place where they still have pain but it doesn't bother them as much as it did. it's a wonderful thing when they get there.
flares and remissions are part of living with chronic pain. people have to be given the tools (in therapy, both physical and psychological) to understand this, overcome the very real fear that this time the pain will never get better, and if a temporary increase in meds is necessary to overcome a flare, the insurance provider needs to understand that too.
last, it's become known that chronic opioids actually cause more pain in the long run. when some people really do become more functional on opioid doses that would drop a horse, they should be allowed to stay on them without being accused of being addicts. addiction, by definition, is use in ever-increasing doses for the psych effects, the high. habituation is the body's response to long use of opioids; when they are withdrawn the body has withdrawal symptoms but that is not a sign of addiction. tolerance is the body's ability to get used to high doses (see dropped horse, above). the highest morphine dose i ever saw in action was 500mg q2hours. that's not a typo-- five hundred milligrams every two hours. the woman was awake, functional, and working part-time.
the only meaningful side effect of escalating opioids is constipation. the others-- temporary drowsiness, decrease in resp rate, decreased bp-- resolve in 24-72 hours, but constipation is forever. plan for multiple bulk-forming and motility agents.
We have no right to judge a persons pain level. If they tell us they are pain, we should treat there pain as they describe it. When working in the veterinary field, animals will never tell you they are in pain, even if their leg is broken and dangling, most are very stoic. The reason is that an injured animal is another animals food, so it is a matter of survival. I am used to treating an animal based on either their injury/disease, or based on very subtle signs that they will show me, if I know what I am looking for. Tightening of the corners fo the lips, blinking, a normally loving pet not wanting to be touched or bothered, hiding and so on...the clues can be many. I have had to treat pets with gun shot wounds, a crushed pelvis, an arrow through the shoulder...and still they purred and did their little happy paws, or licked my face and wanted to be petted.
Take for example women in labor. Some may scream their heads off, some are very quiet...does one feel more pain than the other? A lot has to do with each individual, how they percieve and respond to their pain.
If a person is lying, and only wants their fix, that is not for us to judge or treat. That is for their primary caretaker and/or therapist. Unfortunately it is much easier to get a hold of alcohol or drugs than it is to see a therapist. Many are booked full and most people can't afford to see them.
Additionally, we do not want to treat pain when the symptoms are obvious to us. We want to treat pain before it becomes exacerbated, because we know that pain treatment is more effective if we treat it before it gets out of hand. Better to snuff a small fire than to have to put out a blaze. I too an interested in the process of pain and pain management...it is an issue much more complex than "tell me your pain level".
There's this little thing floating around the social networking sites related to people's careers, where they post a picture showing what their friends, society, themselves, (and whoever else) think they do, and what they really do. I made one for myself, but no one on my facebook could really relate. So I'm sharing it with people who would get it!
Background on my choices:
1) My girlfriends would love to think I have hot Grey's Anatomy romances on the regular. I think that's the stereotype for all nurses in general!
2) Inspired by all the nurses from the floor on which I worked that gave me trouble about not "doing anything" and "losing my skills" when I told them I was leaving for the OR.
3) In response to hearing what I do, laypeople are usually like, "Whoa!! So you, like, see blood?! You see people get, like, cut open?!" and are pretty amazed and horrified at the same time.
4) The next one is self-explanatory. Hellooooo nurse!
5) I'd like to think that I make an impact on the kids I take care of, but by the time they get to me, their so drunk off their little butts from the Versed, they don't remember a thing.
6) I like this picture, but I want to point out at the surgeon appears to be mask ventilating the patient? And the mayo looks like it's above the head. What the what? Haha.
What other alternatives are available to you? Do you have the option to find another clinical site on your own? Is there any way you can do an abbreviated clinical at the site they gave you and then pursue another direction.
From the outside looking in, it sounds as if the powers that be may have taken the easy road with your clinical choice, considering what was best for them and not necessarily thinking about what you needed. If you believe that they acted, not with malice, but with a certain amount of laziness, that tells you that you will probably have to do most of the legwork if you want a better opportunity.
I would suggest finding out where alumni did clinicals and choosing something from those locations that appeals to you. If the facility is already familiar with your school, that may eliminate some of the messy groundwork it takes to establish a connection.
As far as the entitlement issue goes, people who are spoiled and people who are a little fearful because they have a lot riding on their situation can look similar. Keep that idea in mind when your emotions start to boil over. YOU know what's behind your words and your actions, but others may not and they also may not take the time to dig deeper.
One last thing. If you are a praying/believing person, this is a good time to express your thoughts, wishes and desires, and then cultivate an attitude of trust and gratitude, even as you seek to work out an alternative. This can siphon off some of the desperation and clear your head for the kind of creativity it's going to take to make something positive out of your circumstances.
I hope you can find a peaceful and satisfying resolution.
The point here is that I had a simple question and that was could I just not wear jewelry instead of taping my lobes behind my ear.
An LPN cannot work in Labor and Delivery or in ICU. Their education and scope make it so.
I know that there are areas that do utilize LPNs in ICU, but that is a short sided decision. I would never work with an LPN in ICU, who has a patient assignment, and have my own assignment to be responsible for.
Too much responsibilty and accountability for me and my license.
JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Somewhere in the PACNW
Didn't even bother reading responses thus far but why would anyone want to rehash these topics ....again.
I am a nursing student. I am such a big cry baby when it comes to stories about others going through such horrific tragedies. I'm wondering if I'll overcome this or will I be walking around the hospital crying all day?!!
I will always remember the young woman of another culture, advanced in pregnancy when she was diagnosed with breast cancer which had already spread to her bones and brain. Unable to sleep she said to me in her limited English : "Can't sleep, I close my eyes, my children cry and I'm not there". Nothing I could do but sit with her and hold her hand until her sleep meds took effect - Thanks always to my compassionate coworkers who covered my other patients so I could remain with her.
because i love the profession I have chosen, so just because I think it could do with some improvements doesn't mean I dislike what I do. Why do I have to be a doctor just to be more knowledgeable?
The other day my instructor asked us to anonymously answer some questions about the class. A few days later she opens class with, "It has come to my attention that there have been many off topic questions that I have entertained during lecture and stories from your fellow classmates that I have allowed to go on too long. Should these things come up in the future, I will ask that the individual come talk to me about it during break."
During the lecture that day she cut off some of the worst offenders with. "Great question! lets talk about it on break. Moving on..."
After wasting hours of my life hearing about their extended family members, it is over. Sorry if this post is silly, but i am extatic.
I attended nursing school at 33 after being home raising children. Certainly there were lots of highly motivated 20 somethings in my class, with lots of plans for higher education. Some made it, some didn't. I did feel a little envious of them, with no children or families to take care of they could go to any school they wanted, work any hours in just about any hospital they chose (if one got a job she would get her friends in too), and have lots of fun on their time off .. I am friends with some of them on Facebook and I still get to hear about how far they have gone since nursing school..Even though I still envy them a bit, I know my life is different and I am proud of my own acomplishments.
Just goes to show you - you have to look at the whole picture!
reminds me of a situation with a 5 y/o who c/o head pain and there were tears. Her teacher brought her down to our nurses office and my RN wanted me do a everything from a temp to a neuro check. The mom in me took one look at her and I knew pig tails were too tight. LOL
I did enjoy the big hug and thank-you from that little girl. One of my favorite nursing moments.
This whole approach to FORCING healthcare workers to get flu vaccinations is taking a scary turn against our right to autonomy. I was a person who used to believe in vaccinations until I had a horrible experience a little over 1 year ago with a Hep A/B. Within 48 hours of my vaccination, I ended up with a throat tickle that turned into swallowing issues. A few days after that, I ended up with severe tinnitus...so bad that it almost made me drop out of the nursing program. I had to re-train myself to study outside and ignore the noise that just would not go away. The sound was so piercing in the beginning that I was in a fetal position crying and hoping that it would go away. A week after that, my body started having muscle tremors and twitching. Well, that was October of 2010, and I still have the tinnitus, swallowing problems and muscle twitching. Furthermore, my GFR was down to 58, but it is finally back to over 100.
Now, THEY say that there is not enough of any ingredient (i.e. thimerosal, neomycin, etc.) to do harm. However, there are certain individuals who are sensitive to these ingredients. Any chemist would tell one that even the smallest amount of mercury can do big damage to a neuron. Plus, we all know that aminoglycosides are oto and nephrotoxic.When I read the prescribing package insert on the HEP vaccination, I saw that my symptoms were documented side effects, but I was part of the 1%. Well, don't the 1% count at all?
It seems that individuals who have strong opinions against vaccinations end up being judged as as ignorant. It's difficult to find medical proof against vaccinations because there is poor follow up with VAERS (Vaccine Adverse Event Reporting). I filed a VAERS form after the HEP vaccination, and all they do is call your doctor (who will tell them it is a coincidence that all of these symptoms suddenly appeared after the vaccination) and then send you a letter 1 year later to see if you are still experiencing the symptoms. That is it!
I just graduated and am SCARED TO DEATH to put anything in my body like a FLU SHOT that contain things like mercury, formaldehyde, etc. Oh, and what about the aluminum that is meant to stimulate the immune response? Last time I checked aluminum was found in the brain of Alzheimers patients...how does it get there???...deoderants containing aluminum, flu shots, environmental exposure??? (that is food for thought). The bottom line is that we are being bombarded by environmental toxins every day without even realizing it, so why can't we have a choice as to whether or not we want to toxify ourselvers more?
I don't know what the answer is, but I think more research has to be done in following those individuals that have adverse outcomes to these vaccinations.
Oh, and as a fun fact: the TWINRIX prescribing information insert states "TWINRIX has not been evaluated for its carcinogenic potential, mutagenic potential, or potential for impairment of fetility."
A Nurses Christmas
T'was the night before Christmas
& all through the floor,
The Lasix was filling the foley's galore.
Stockings were worn, to prevent emboli,
They came in two sizes: knee, and thigh-high.
The patients were nestled half-assed in their beds,
While visions of stool softeners danced in their heads.
We in our scrubs, and they in their gowns,
Fashions created to hide extra pounds.
When down in E.R. it became such a zoo,
They called with admissions, for me and for you.
They're coming, they're going, they're looking the same,
My patience for patients is starting to wane.
Another call light is ringing, the patient expounds,
"I have not had my peri-care, please send someone down."
About now delegation seems a good plan,
We pass onto others, the needs of this man.
When what to my wondering eyes should appear,
But Santa himself, and 8 tiny reindeer.
He states that he came from Central Supply,
To bring us LR, NS, and D5.
The doctor then scribbles what no one could read,
Orders instruct us to measure their pee.
As we try to decipher illegible words,
We find a new order to guaiac their turds.
The next shift arrives; our day is now through,
Only to discover emesis inside of our shoe!
We give them report and pass on the facts,
And tell them of duoderm lining the cracks.
And the Nurses exclaimed as they drove out of site,
Let there be Ambien for all, and to all a good night!
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