1/16 What I learned this week: Siamese Twins be Pimpin'

Nurses General Nursing

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Specializes in critical care.

After last week's fun and games, I'm feeling rather boring!

Here is what I've learned:

1. Hepatitis, PVD and pyoderma gangrenosum are a horrible combination for medical history. HORRIBLE!

2. Chasing a person's heart rate, blood sugar and blood pressure all night long while this normally walkie/talkie person won't wake up, makes it a bit frustrating to have an extremely conservative hospitalist on board that night.

3. Going completely out of your way for a complex dressing change (moving slowly to let pain ease, knowing the lady in #2 will be crashing again soon) makes it incredibly frustrating to learn this guy complained about getting two changes in one shift. Dude. First time was for assessment and that shizz was nasty. Second time was because dude acted like he had compartment syndrome (he did not), and the bandage was again nasty.

4. I've been a city mouse in the country way too long.

5. My little girl does not want to be a nurse when she grows up, but she does very much want to learn nursing stuff. Her timing could not be more perfect. My son helped me study for my bachelors degree. Now she can help me with my doctorate!

6. That same little girl has been a wonderful wound care nurse for my biopsy site.

7. The original Siamese Twins had 21 total children. Their cause of death - one had a stroke and died a few days later. Apparently you don't survive having a dead person's blood running through you. Incidentally, they shared a liver.

8. Morphine is a hell of a drug.

9. It is actually possible for a systolic blood pressure to go from 90s to 190s and back to 90s in the span of a half hour without medication being administered and with absolutely no change whatsoever in patient or blood pressure cuff. (Would absolutely love to hear theories on this.)

10. People respond better to smoking cessation education when you cut them some slack.

11. Smokers can also sniff out a never-smoker from a mile away. I'm sorry to say it, guys, but many (if not most) of these smokers are tuning your out as soon as they hear, "quit smoking". It has nothing to do whether they're considering quitting or not. They know you don't know how hard it is to quit and they feel judged.

12. Scarlet fever comes with a white strawberry tongue.

13. If you're getting lidocaine SQ/IM, ask for a nurse to give it to you. I have gotten this stuff from doctors and they just go grab the biggest needle, draw a bunch up, and shove it in. This NP grabbed an SQ of reasonable size, injected a tiny bit, waited, then injected the rest rather slowly, making sure the first part was able to numb the rest. This is why nurses rock. We think of stuff like this.

14. Hope for Alzheimer's research: the brain of a mouse has lymphatic vessels, draining fluid and WBCs from the brain. Also, medications which enhance the "brain cleaning" system (preventing/decreasing the amount of tau buildup) are being researched. Unfortunately, those already known to be affected won't benefit from this research. But it is certainly promising for those of us being left behind by Alzheimer's sufferers.

15. Apparently a kid played a trick on his nurse mom by convincing her she won the Powerball. If any of you is that mom, I'm sorry. So, so sorry.

Alright, peeps. How about you? Learn anything good?

Specializes in Med Surg/PCU.

1. Idiopathic pulmonary fibrosis sucks.

2. A whipple procedure results in a way bigger scar than I ever suspected.

3. I'm not sure I'm cut out to be a preceptor. My first go-round was an epic fail.

Specializes in OR, Nursing Professional Development.

I learned what pyoderma gangrenosum is. Thanks, Google for finding it for me and ixchel for mentioning it.

I've learned that a surgeon working with a team learning a certain procedure can be a complete orifice to the people learning.

I've learned that hearing a patient who came into the OR with zero expectation to survive will defy the odds and leave the hospital under their own power (after many, many weeks in the ICU) with some deficits that will never go away, but they will still leave the hospital.

I've learned that it is very gratifying to learn that success can be snatched from the jaws of death (regarding the above).

ETA: I've learned my computer likes to correct ixchel to extol. Bad autocorrect!

Well, this past week was a lot more interesting for me than it usually is, and it's my first week of class!

I learned how to read EKG strips and identify the basic cardiac abnormalities. Any ventricular dysrhythmias tend to be more critical. V-fib and V-tach can give you a pulseless patient if you don't get catch it quick enough: Code Blue.

If you're calling a physician at night, always have your ducks in a row. More likely than not, they won't really want to speak to you.

For dysrhythmias, don't use a Dinamap because there is apparently new research that possibly indicates inaccurate BP readings - use a manual cuff.

12-lead EKGs are use for diagnosing heart rhythms, as opposed to telemetry.

Specializes in Pediatrics, NICU.

1) I learned what whippets were! (Too soon?) :cheeky:

2) I learned that I really really don't care for the delivery room. I much prefer just receiving babies in my unit instead of getting them fresh from the source in the DR.

3) I learned that trying to divide up an unfair assignment will still get people mad at you even though they would probably be mad if you left it unfair. Sorry for trying...

Specializes in Hospice.

1. I learned that my Medical Director can get so upset over inadequate pain management (PRN Tylenol for a terminal cancer patient) that he literally vibrates and lightning shoots out of his eyes (ok, that last part maybe not so much, but he was PISSED!).

2. I learned that my sweet, pleasantly confused LOM will undergo a complete personality change when the women at his meal table scream and carry on enough to get on his last nerve. And that while everyone at the facility agrees with me, so sorry, nowhere else to move him. [emoji35]

3. That I would much rather recuperate from my URI this weekend than the noro virus stomach flu the rest of my co-workers are coming down with.

4. That coughing up mucus plugs is just as nasty as I remember it.

5. That "post-tussive emesis" sounds WAY more elegant than "coughed so hard I threw up".

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I learned....

1. That 'assessing' a patient as a case manager is different than assessing them as a floor nurse. Now that I am a case manager, I am not to lay a finger on the patient. My assessment consists strictly of questioning them.

2. That working from a home office is less stressful than reporting to somebody else's physical workplace.

3. That I still have a massive learning curve to overcome. However, if switching specialties had been too easy, it wouldn't be worth it. We tend to value the things in life that we put a lot of work into.

1. I learned changing wound vac dressings on huge abdominal wounds goes better with two nurses. And most of the time, one nurse does it. :confused:

2. I learned I was right about floor nursing and those darn computers taking your attention away from your patient. Oh and they aren't called COWS anymore. :sarcastic:.... I guess patients complained that nurses were calling them cows. ;)

3. I learned I'm nearing the end of my nursing career and doubt I could be as good a nurse in the ER or L&D as I used to be. My mind just doesn't work as well.

(Gotta go - my 14 year old and I are watching Hawaii 5-0 on Netflix).

I almost never suggest "quitting smoking" to my clients anymore because, absolutely, the automatic answer is "NOPE". Instead I've been having better luck suggesting using nicotine patches to help them "cut down a little bit." It's all about realistic goal-setting.

I don't know if family physicians are just getting a ton of pressure to slow down on prescribing opiates, but I've been having a rash of palliative/hospice clients with nothing but stupid things like Tylenol or diclofenac for their cancer pain. Really? Really? What in the hell is Tylenol going to do for my clients? My little old lady with ovarian cancer, belly as big as a beach ball, taking enough Tylenol to fell a horse and finding no relief. WHAT A SHOCKER. For the love of god can we get this woman some opiates?! I'm not ashamed to say I spoke a little sharply to the doc when I called her that day. At what point is it no longer "conservative" and becomes unethical, poor treatment, irresponsible?

I've learned that cancer still sucks.

David Bowie and Alan Rickman RIP.

Pancreatic cancer is on my crap list especially right now.

I've learned that holding a baby with attitude and fuzzy baby hair goes a long way to soothing my soul.

I've learned that the music group I keep liking is twenty one pilots and I'm going to pay more attention to what I listen to.

Ixchel's #14 made me hopeful for the future, but not the near future.

I don't know of any conjoined twins, but I do remember the picture of those twins in my brother's Book of Lists in the 70s.

I do know of a baby that was born with a tail. :bag:

Specializes in retired LTC.

This week I learned that:

1 - it's often the MOST mundane little things in everyday life that often makes such a big difference and awareness. Like how much we all rely on our laundry clothes dryer. I bought/installed a new condo, apt-sized piggyback washer-dryer combo on 12/26 after my old one died early November. I had to do daily laundry r/t old machine's size and needing to hang things in my bathroom to dry. It is such a new luxury to NOT do daily laundry!!!

2 - I'm SHORT! With the new washer/dryer, I've found that I'm having difficulty reaching the bottom of the washer tub and the back of the dryer drum. I WILL NOT complain (see #!)

but I have to use one of those reacher/grabber thingeys that the old people in the NH use to pick up stuff from the floor.

3 - dealing with my 'sinsurance' company is soooooo frustrating. It's been one problem after another. The telephone representatives are all very nice and I believe they really try to be helpful, but it's exasperating that problems still snowball.

4 - I think I used to do that whipcreme/nitrous oxide thing when I was a kid. I loved to squirt the can into my mouth and I learned to make sure the can was really upside down to squirt. If it wasn't right, I would just get a whiff of propellant. But propellant "tasted good" too as I remembered.

The BP going from 90 to 190 in 30 min. Could it be pheochromocytoma?

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