Latest Likes For ixchel

Latest Likes For ixchel

ixchel, BSN, RN 39,379 Views

Joined Jun 3, '11. Posts: 5,062 (75% Liked) Likes: 19,399

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  • 4:16 am

    Quote from LadyFree28
    I learned:

    I still get triggered but can handle any DV, or PTSD pts; being proactive in their journey by educating, supporting and giving resources about the "experience", while not putting myself in their shoes and self-preserving and remaining in the clinician role while empowering, is exhausting and all in the same night will make me wake up with some form of an emotional hangover...I only expect it to get better.
    I just want to hug you. I've come to realize in the last several months that I get triggered by DV/abuse/neglect patients, and I don't do well handling it. Adult inpatient, it is very rare I am able to impact a resolution to the situation. We send them back where they came from with no ability to do a single thing more. I'm working on it. Hopefully I can find a way back to the resilience I used to have, and then the ability to accept I can't do more.

    Incidentally, tomorrow is National PTSD Awareness Day. For my sisters and brothers who are already so painfully aware, my heart is with you.

  • 4:16 am

    Quote from OrganizedChaos
    I have been sick. First I had the migraine of all migraines for a whole week. Then if that wasn't bad enough I got the mother of all UTIs. I haven't had a migraine or UTIs in so long & both were the most painful things I ever experienced. Child birth wasn't that bad compared to my migraine & the UTI.
    I am still trying to get better. I'm still exhausted from being sick & a little nauseated. I don't wish that migraine or UTI on anyone.
    I hope you get better quickly, Cheerios!

  • Jun 28

    Quote from LadyFree28
    I learned:

    I still get triggered but can handle any DV, or PTSD pts; being proactive in their journey by educating, supporting and giving resources about the "experience", while not putting myself in their shoes and self-preserving and remaining in the clinician role while empowering, is exhausting and all in the same night will make me wake up with some form of an emotional hangover...I only expect it to get better.
    I just want to hug you. I've come to realize in the last several months that I get triggered by DV/abuse/neglect patients, and I don't do well handling it. Adult inpatient, it is very rare I am able to impact a resolution to the situation. We send them back where they came from with no ability to do a single thing more. I'm working on it. Hopefully I can find a way back to the resilience I used to have, and then the ability to accept I can't do more.

    Incidentally, tomorrow is National PTSD Awareness Day. For my sisters and brothers who are already so painfully aware, my heart is with you.

  • Jun 28

    Quote from OrganizedChaos
    I have been sick. First I had the migraine of all migraines for a whole week. Then if that wasn't bad enough I got the mother of all UTIs. I haven't had a migraine or UTIs in so long & both were the most painful things I ever experienced. Child birth wasn't that bad compared to my migraine & the UTI.
    I am still trying to get better. I'm still exhausted from being sick & a little nauseated. I don't wish that migraine or UTI on anyone.
    I hope you get better quickly, Cheerios!

  • Jun 28

    Quote from AJJKRN
    Hope your son has a quick, safe, and un-eventful turn around!
    Thank you so very much! He managed to tolerate the doxy very well. All signs of rash gone. No fevers or body aches. He's back to torturing Girl Child. (That last part is not so nice. :\)

  • Jun 28

    Aerosmith - Back in the Saddle - YouTube

    IXCHEL IN DA HOWWWWSSSSEEE!!!!

    Okay, not entirely since my back still sucks, but still... I've gotten my lazy brain wrapped around hosting this shindig for a good go-'round. How are you all this week?

    It's been a weird few weeks. Well, to be fair, it's been a weird few months, but for the purposes of the here and now, WEEKS. Brexit googling, Scotland succession, and the Donald re-establishing that Americans can still win the "who can look more ridiculous" contest. The best episode of anything ever in existence came on HBO last Sunday at 9 pm, and the memes that resulted were actually disappointing. (Except for one of a pile of dog poo alluding to a character returning in season 7.) I got a mosquito bite on the bottom of my foot. (Might be the worst spot ever.) What have I learned???

    Well...

    Boy Child got Rocky Mountain Spotted Fever (RMSF).
    A pediatric hospitalist made me realize that if I ever travel outside my geographic area and provide care to patients, I should learn the epidemiological trends of that area.

    Never, EVER ignore petechiae on the feet. It is relevant to the differential, especially on a child.

    RMSF is reportable to the CDC, and from 2000-2010, there were 2,000 total cases reported per year.

    The typical presentation of RMSF is fever, then rash, with a recent tick bite (1-2 weeks prior). The rash will be flat, pink spots, and sometimes blanchable. It will begin in limbs and move toward the trunk. Later in rash development, petechiae will appear on the hands, feet and ankles. If the petechial rash develops, it's typically several days (up to a week) after fever onset.

    RMSF attacks vital organs, including the heart and brain. Boy Child's first BAM! symptom was syncope. I did't see the petechiae on his feet until we were at the hospital. There, we also noted sinus tachycardia and alterations in mental status.

    Unfortunately, not everyone gets the rash.

    In the 1940s, around 28% of those who contracted RMSF died. In the 2010 data, 0.5%. (Doxy is a helluva drug!)

    In other news...

    Post op after spinal fusion requires more patience and endurance than I think I have.

    I don't know how to make my pool water clear.

    The sun burns shock off a small pool way too quickly.

    I miss work, but I don't know if I'm actually recovered enough to go back.

    Littlefinger is still a creepy *****.

    If AN ever decides to censor ***, ******, *****, or *****, I will be a sad, sad ixchel.


    I added the link at the bottom of this days ago and can't remember what it is. We'll be learning this together.

    Zachary Quinto performs George Michael's "Freedom! '90" (with Cindy Crawford) | Lip Sync Battle - YouTube

  • Jun 28

    And if the provider does happen to feel bothered, maybe they should pay better attention while putting in orders.

    What gets me is when each doctor within a specialty feels passionately about something, only they have opposite opinions.

    NPO before cardiology review for CP and negative biomarkers?

    One will freak out you ordered it. The other will freak out if the patient even smells food. Grrrr yell at the hospitalist for missing the right diet order! Not me!

    I use "nursing judgment" in charting skipped orders sparingly, but I do use it. Nursing judgment means you are willing to go on the record to say what was ordered wasn't appropriate or safe at that time, even though numbers say it was. If the physician disagrees, it'll be ugly. Stand your ground if you are right!!! If they agree with your judgment call, they'll be thankful since you might have just saved their butt.

    Always put your head together with a nurse you trust is knowledgable if you aren't sure what to do. I find myself talking with other nurses through these scenarios, to be sure I haven't missed something.

    You're doing an excellent job thinking through these things and knowing they need to be thought of!

  • Jun 28

    And if the provider does happen to feel bothered, maybe they should pay better attention while putting in orders.

    What gets me is when each doctor within a specialty feels passionately about something, only they have opposite opinions.

    NPO before cardiology review for CP and negative biomarkers?

    One will freak out you ordered it. The other will freak out if the patient even smells food. Grrrr yell at the hospitalist for missing the right diet order! Not me!

    I use "nursing judgment" in charting skipped orders sparingly, but I do use it. Nursing judgment means you are willing to go on the record to say what was ordered wasn't appropriate or safe at that time, even though numbers say it was. If the physician disagrees, it'll be ugly. Stand your ground if you are right!!! If they agree with your judgment call, they'll be thankful since you might have just saved their butt.

    Always put your head together with a nurse you trust is knowledgable if you aren't sure what to do. I find myself talking with other nurses through these scenarios, to be sure I haven't missed something.

    You're doing an excellent job thinking through these things and knowing they need to be thought of!

  • Jun 28

    Quote from KatieMI
    Oh, yeah.

    ASA and Plavix from Cardiology #1, as a gold standard for stents protection;
    +
    Heparin drip for subtherapeutic INR for coumadin bridge for being gold standard for stroke prevention by Cardiology #2
    +
    aforementioned coumadin in increasing dose by Neurology
    +
    Lovenox SQ as golden standard for PE prophylaxis on high risk patients (the guy is indeed high risk) by hospital internal medicine.

    The guy happened to be somewhat of VIP. It was kinda funny seeing those four docs plus critical care one loudly quarreling between each other about who was going to be responsible for the utter mess named "expanding retroperitoneal hematoma" while the unconscious victim of their best intentions and gold standards was dragged down to ICU.
    Honest to god, THIS is where protocols SHOULD be, but instead we get protocols for stupid crap, taking away their autonomy when it should be allowed.

  • Jun 28

    And if the provider does happen to feel bothered, maybe they should pay better attention while putting in orders.

    What gets me is when each doctor within a specialty feels passionately about something, only they have opposite opinions.

    NPO before cardiology review for CP and negative biomarkers?

    One will freak out you ordered it. The other will freak out if the patient even smells food. Grrrr yell at the hospitalist for missing the right diet order! Not me!

    I use "nursing judgment" in charting skipped orders sparingly, but I do use it. Nursing judgment means you are willing to go on the record to say what was ordered wasn't appropriate or safe at that time, even though numbers say it was. If the physician disagrees, it'll be ugly. Stand your ground if you are right!!! If they agree with your judgment call, they'll be thankful since you might have just saved their butt.

    Always put your head together with a nurse you trust is knowledgable if you aren't sure what to do. I find myself talking with other nurses through these scenarios, to be sure I haven't missed something.

    You're doing an excellent job thinking through these things and knowing they need to be thought of!

  • Jun 28

    Quote from OrganizedChaos
    I have been sick. First I had the migraine of all migraines for a whole week. Then if that wasn't bad enough I got the mother of all UTIs. I haven't had a migraine or UTIs in so long & both were the most painful things I ever experienced. Child birth wasn't that bad compared to my migraine & the UTI.
    I am still trying to get better. I'm still exhausted from being sick & a little nauseated. I don't wish that migraine or UTI on anyone.
    I hope you get better quickly, Cheerios!

  • Jun 28

    Quote from AJJKRN
    Hope your son has a quick, safe, and un-eventful turn around!
    Thank you so very much! He managed to tolerate the doxy very well. All signs of rash gone. No fevers or body aches. He's back to torturing Girl Child. (That last part is not so nice. :\)

  • Jun 28

    Quote from NotAllWhoWandeRN
    You don't want AN to be come ineffable?
    How about a compromise: AN remains effable, while its posters remain ineffable.

  • Jun 28

    Aerosmith - Back in the Saddle - YouTube

    IXCHEL IN DA HOWWWWSSSSEEE!!!!

    Okay, not entirely since my back still sucks, but still... I've gotten my lazy brain wrapped around hosting this shindig for a good go-'round. How are you all this week?

    It's been a weird few weeks. Well, to be fair, it's been a weird few months, but for the purposes of the here and now, WEEKS. Brexit googling, Scotland succession, and the Donald re-establishing that Americans can still win the "who can look more ridiculous" contest. The best episode of anything ever in existence came on HBO last Sunday at 9 pm, and the memes that resulted were actually disappointing. (Except for one of a pile of dog poo alluding to a character returning in season 7.) I got a mosquito bite on the bottom of my foot. (Might be the worst spot ever.) What have I learned???

    Well...

    Boy Child got Rocky Mountain Spotted Fever (RMSF).
    A pediatric hospitalist made me realize that if I ever travel outside my geographic area and provide care to patients, I should learn the epidemiological trends of that area.

    Never, EVER ignore petechiae on the feet. It is relevant to the differential, especially on a child.

    RMSF is reportable to the CDC, and from 2000-2010, there were 2,000 total cases reported per year.

    The typical presentation of RMSF is fever, then rash, with a recent tick bite (1-2 weeks prior). The rash will be flat, pink spots, and sometimes blanchable. It will begin in limbs and move toward the trunk. Later in rash development, petechiae will appear on the hands, feet and ankles. If the petechial rash develops, it's typically several days (up to a week) after fever onset.

    RMSF attacks vital organs, including the heart and brain. Boy Child's first BAM! symptom was syncope. I did't see the petechiae on his feet until we were at the hospital. There, we also noted sinus tachycardia and alterations in mental status.

    Unfortunately, not everyone gets the rash.

    In the 1940s, around 28% of those who contracted RMSF died. In the 2010 data, 0.5%. (Doxy is a helluva drug!)

    In other news...

    Post op after spinal fusion requires more patience and endurance than I think I have.

    I don't know how to make my pool water clear.

    The sun burns shock off a small pool way too quickly.

    I miss work, but I don't know if I'm actually recovered enough to go back.

    Littlefinger is still a creepy *****.

    If AN ever decides to censor ***, ******, *****, or *****, I will be a sad, sad ixchel.


    I added the link at the bottom of this days ago and can't remember what it is. We'll be learning this together.

    Zachary Quinto performs George Michael's "Freedom! '90" (with Cindy Crawford) | Lip Sync Battle - YouTube

  • Jun 27

    Quote from KatieMI
    Oh, yeah.

    ASA and Plavix from Cardiology #1, as a gold standard for stents protection;
    +
    Heparin drip for subtherapeutic INR for coumadin bridge for being gold standard for stroke prevention by Cardiology #2
    +
    aforementioned coumadin in increasing dose by Neurology
    +
    Lovenox SQ as golden standard for PE prophylaxis on high risk patients (the guy is indeed high risk) by hospital internal medicine.

    The guy happened to be somewhat of VIP. It was kinda funny seeing those four docs plus critical care one loudly quarreling between each other about who was going to be responsible for the utter mess named "expanding retroperitoneal hematoma" while the unconscious victim of their best intentions and gold standards was dragged down to ICU.
    Honest to god, THIS is where protocols SHOULD be, but instead we get protocols for stupid crap, taking away their autonomy when it should be allowed.


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