Malanya

It seems like a running joke around here -- especially if it's the family who went ahead and packed the bag, cuz... like, they can go home and GET the stuff if it's needed. I just got discharged after a two day stay due to an asthma exac complicated by pneumonia in my good lung (my bad lung has a lot of scarring, collapsed aveolar sacs, and apparently a granuloma from the CT they did from an extended bout of pneumonia years ago), admitted through ER. I don't have any family in 200 miles, so there was no one to pack anything for me. (Friends are apparently far from reliable.) If I'm ever in an exac again, and it's as severe as it was -- the only way I could get any airflow was breathing very shallowly, and I was tempted to use my epi-pen while waiting for transport when I was dizzy sitting down, but had already used my MDI at least 12 times that night and wasn't sure how much of the dizziness was from all the inhaler use.... well, I'm gonna be one of the people you laugh at for bringing a bag just in case. (Obviously if they kept me two days it was pretty darn bad.) Cuz as much as the fancy lingerie provided by the hospital flatters my figure (105 lbs) and must cost your hospital a fortune.... it's ... well.... uncomfortable.

As long as the way the chronic psych patient is wanting to avoid "feeling" is the extreme pain of EPSE, your first reaction would be legit IMHO. While I've never been combative in an ER, a situation did arise where I was given Haldol, and developed severe EPSE. I have never been in that much muscular pain in my life, and it wasn't confined to just one muscle group. Really, given that less potent neuroleptics are less likely to cause EPSE and NMS, I don't understand why haloperidol and droperidol are still so commonly used. It might be a bigger shot to use Thorazine, but if your combative is screaming "No Haldol", there might be a reason that's more than just that they don't like how it "feels"....and if you aren't sure why they're rejecting one particular one, go for one that has a slightly less intense side effect profile JIC.

Sorry for bumping an old thread, but I just have to say those might be the best orders I've seen on this thread!

See, that's what I meant, sorry, I get my terminology confused sometimes...

Thanks for all your thoughts, and I hadn't thought about Toradol possibly adding a contribution to the exac. My PCP said the cxr was okay except for a bit of cloudiness in the lower right lung that may be scarring from pneumonia when I was younger. He didn't hear any sounds indicating it was more than just scarring in that area. I'm going back for a followup in December and he wants to take another cxr when I am fully well and not having symptoms to use as a base to compare from in the future, hopefully I'll find out about the approval for a home nebulizer then. I don't know about any visits... I was just meaning the almost what I would call aggressive or CYA thing about pain. I mean, I appreciate it, and I'm glad to know that if I'm ever really in need of that kind of pain relief that it'll be available. And I have to admit that I did subjectively feel like I was breathing better after it. But I've had several ER visits for exacs in the last decade and that's the first time I've ever been given that. Take care of yourselves, and I'll keep reading your threads and being happy that I'm wanting to do psych nursing instead of the ED...

Hi, it's been awhile. Hope you guys are keeping on keeping on. I've been doing fairly well, but my asthma has been requiring more vigilance to keep it fully under control lately, and it doesn't seem to take much to get me sick. I had to go to the ED for an exac recently, though, and while most of the visit was routine, the way pain was addressed on a completely non-pain related visit kinda shocked me. Is this just the way things are now? The full story: The weekend right before Halloween I managed to sprain my back trying to work on my new house. When I went in to see my PCP he noted that I was wheezing a bit more than normal, we made a note that next visit I needed to get my PFTs redone, and I learned the power of Toradol for the first time (the shot took a bit to start working but within half an hour I could have kissed that doctor). When I'd had orthopedic pain before he'd written Celebrex and it worked well, so he wrote that as well as some Flexeril... and Vicodin, which may have been the mistake. Over that next week my back slowly got better, but my breathing got much worse -- I had to use my rescue inhaler twice the first night on it. I had also been fighting nausea all week -- coughing too much does it to me, plus I'm sure the narcs added their contribution. I only needed the Vicodin at night by the end of the week, so that's the only time I was taking it, but by Sunday night I had the full-on crud and was running a fever hacking puking all night.... and my doctor was already booked up for the entire day on Monday when I got through. I made an appointment for the next day but I guess I sounded bad because I got a callback 15 minutes later from my doctor, who asked me a few questions, had me use my rescue inhaler six times in a row... then told me to go to the ER because I still wasn't able to speak in complete sentences. Fortunately a friend was able to drive me, I really didn't trust myself behind the wheel, and I was right -- O2 sat 87 in triage. The triage nurse learned about the back problem because of my current medications, but when she asked my pain levels I said "Maybe a 2 but it's not on my radar at all right now." It wasn't. Everything seemed pretty standard after that -- saline lock, blood, UA, they did a chest x-ray and then a resp tx... I was still pretty wheezy after but I did respond some. Then this is when it started to get weird, or at least it felt odd to me. The doctor apparently ordered fluids and Zofran, and another resp tx for after the fluids were started, but also Ativan. And I got the feeling the nurse was uncomfortable with the dose ordered of Ativan, or at the very least she was trying to do her best not to snow me completely with it (I don't know what amount was ordered but I'm only 5'1 and 130 lbs, doesn't take much for me)... she pushed the Zofran but she spaced the Ativan out in the line so it wouldn't knock me straight out. As it was, I could barely finish the second resp tx. I won't deny I needed the rest, and I was happy to sleep without struggling to breathe or struggling not to puke, but I'd never been sedated in the ER before. After a few hours the doctor woke me up and listened to my breathing, said that the chest xray and labs were all good (yay!) but he wanted me to follow up with my doctor... He wrote Phenergan and Cipro, then said that he thought I should have an antibiotic and steroid shot as well, and that the nurse would be in. I was still pretty dazed. When the nurse came in, she said, "By the way, the doctor was worried about you, he said you were crying out in your sleep." I said I didn't know why, that "my back hurts a little, but..." and started to say I had meds at home for that. She cut me off. "Well, this morphine will fix that." ????????? I was *extremely* surprised, and the only thing I could think of to say in response to that was "Well, if you're going to do that I'm doubly glad that my friend was able to drive me today." I accepted the medication... I figured it meant I wouldn't have to take any of my home medication the rest of the night, and knew I wouldn't be behind the wheel. After that and the Rocephin/Decadron my friend came and picked me up, took me home and put me to bed, then went and got my scripts filled for me -- I was barely able to keep my eyes open on the way home. -------- When I followed up with my PCP I asked about getting a home nebulizer so that I can give myself breathing treatments if I need to instead of having to go to the ER, and he seems to think it's a good idea, so hopefully I won't have to go back to the ER for a long time. But is it standard to administer narcs in a situation like that? Honestly, I would have been happier with Toradol now that I've had it once and know how well it works -- I don't like the nausea and sleepiness from narcs. It just seems backwards to have gotten an anti-inflammatory shot when I was in absolute agony and narcs when I wasn't even c/o of pain as my reason for being there.

Hate to bump old threads but people always comment on awful names, it'd be cool to see some more good ones. We're kind of stuck in picking names -- I'd love to name a son after my grandfather, but I won't stick a child with Marvin or Clarence. (Well, maybe Clarence as a middle name). My man insists that he wants to name his first son after HIS grandfather, who was Harrison. I have always loved Donovan, so if we have a son he will be Donovan Harrison. It's a very strong name, I hope he doesn't get teased too badly. For girls... I've always loved the name Audrina (found it in a VC Andrews book, it's not as much the character I like as the name, my mom can't get over the character and the theme of the book so she's not too fond of it.) My man likes Audrey, so we may go with Audra or Audrey. For a middle name, I really want to name a child after my sister, whose middle name is Renee. (It's a common thing in our family to pass on middle names). My sister is likely not going to have any children, they've been trying now for five years and she's getting close to 40 now so it's not that likely -- they don't want to do fertility treatment, but after this long it may be the only way. So a girl will likely be Audrina (or Audrey) Renee. We have no idea what a second boy would be named, and as for a second girl name I really want to go with Christina Anne. My younger half-sister, who was given up for adoption, was named Tina Ann. So we'd be naming a second daughter for her. We want two kids max, so we're trying to figure out two girls names and two boys names. Any other names that you have come across that you really like? It's so easy to pick out names you can't stand, but the really good ones are hard to find.

I'm not a mom yet. So I can't say what I say as a mom, or as a nurse yet because I'm still a student. In our family, cosleeping would be unsafe. We have a waterbed with a mattress pad on top of it. I am a light sleeper but I also toss and turn. My man has back issues, so he rolls over frequently. We are not designed for cosleeping. But I plan, when we do have kids, to get one of the Arm's Reach cosleepers that is beside the bed. That way I can nurse without having to get out of bed, and will be able to comfort my child by my presence even if it's not any more physical than a hand resting on their back. I will just have to be as careful as I can not to fall asleep while nursing. I do know several parents who cosleep at least occasionally. They have firm mattresses without pillow tops, and baby sleeps in the middle between them on large beds. They use small pillows and their heads are on them all the time. Also, none of the parents I know who cosleep use comforters -- blankets that can be tucked in easily are what they prefer. Fortunately my gentleman had a child from his previous marriage, so he is very well-prepared to be a parent. Apparently his ex-wife was not, and he cared for their baby most of the time. When we talked about parenting and I talked about a bedside cosleeper, he said "Cool, that means I can take care of her without waking you up or getting out of bed." "What, you think it's going to be on your side of the bed?" "Yeah... my daughter's bassinet was on my side of the bed..." "Yeah, but it'd be really awkward to roll over you to get her to breastfeed..." "You're going to breastfeed???" He was shocked that I seemed interested in actually being a parent since it was so beyond his previous experience. So likely when we do have kids we're both going to be taking care of them, if not equally at least close to it. (He also said that "it's the man's job to deal with toxic wastes" -- aka diapers. Wow!!!)

I saw this thread. I'm still a student, so my thoughts may be based on the merry glow of knowledge with no experience yet... But if a patient is in hospice care, the goal is amelioration of suffering, improving quality of life, and comfort until the patient dies, right? I'm assuming the patient wouldn't be in hospice care unless they were terminal? In that case... I would be less concerned about addiction and more concerned about quality of life. If the medications are causing them to have a WORSE quality of life, then I'd be concerned. But if they're keeping his pain level at the best it can be, allowing him to enjoy the time he has left as much as he can... then it would seem they were doing the job. I don't know if I'd be able to work in hospice care. Then again it may be rewarding enough, being able to give comfort and being able to help the patient and his family through the dying process, that it might be worth it.... I just don't know if I'd have it in me. Thanks to all of you who do what others cannot!

I apologize if my question brought down the mood. If you don't laugh you cry, I know that. I certainly wasn't trying to tell anyone not to laugh. Believe me on that, please.

I'm fairly large (4'11 and 180) so I can understand the issue. Like other people said, sounds like the needle didn't actually get into muscle. Fortunately I don't have much fat over my glutes as opposed to my thighs and stomach, so I haven't had that problem. My father is an IV drug user, so I agree here. My dad now has a port, but in the past he's told doctors which veins still were good. He's been able to find doctors who are somewhat sympathetic to his situation (now been HIV+ for over 15 years and full blown for 10) and while they won't write him narcs or other high abuse potential drugs, they keep track of his condition closely. Dad actually hasn't done any IV drugs for several years -- he switched from IV meth to crack. *sigh* From his experiences I would agree with most of the people on here -- if you're an IV user the other methods of getting the drug just aren't what the person is looking for. Dad has said often enough that he'd never snort meth, that only the IV buzz gives him what he wants. In your sister's case it wasn't what she WANTED, it was what she needed -- the pain relief, not the buzz, and the needle just couldn't get into the muscle.When he was in jail a few years ago, they needed to draw blood but didn't have the stuff needed to flush his port. The jail nurse tried to stick him once, then handed him the rig and had him do it himself. He got it first try, but not on the vein the nurse went to first. I keep telling him he ought to get clean and after he'd been clean long enough that they'd hire him, become a tech and work at a blood bank doing withdraws. But he's too caught up in his addiction to even try to make something good of himself, and being HIV+ they might not want him. -------- I have a question for you full nurses (I'm just a student). In your experience, are the families of junkies more or less likely to become addicts themselves? I feel very lucky that I went to Alateen. Alateen is not just designed to help a person deal with their parents' addictions, but also to help recognize addictive thoughts and patterns of behavior in themselves. Because of those lessons, I'm considered by most of the people I grew up with to be the "furthest thing away from an addict". I occasionally drink, but only with friends, and usually only on NYE. I may have a glass of wine if I go out to dinner, and it's a special occasion. From the first time I ever drank, I set rules for myself -- I would not ever keep alcohol in my home, I would not drink except wine or mixed drinks at a bar or restaurant, I would not drink alone, I would never drink without eating something more than an appetizer, and I would not drink if I was in a bad mood or was trying to escape a problem. I've followed those rules. If a doctor gives me medication I know can be habit-forming, I tell them about my father's addiction and request that they try to find a medicine that's not habit-forming. When they can't, I try to take the least I can, for the least time I can. I think I've done pretty well. I'm also with a person who does not drink at all except a half-glass of wine occasionally when we go out. But in your experience, is this a common way for the family members to act, or is it more common for them to fall into the same trap? For me, I would never want to put people who cared about me through the hell that my father's addiction did to our family. I would hope that others would have the same thoughts. Thanks!

I don't know if this is correct, but I would guess "brought in by ambulance". (Still a student myself, so I am still trying to learn all of the acronyms that everybody uses, don't know if I'm right...)

i truly wish that for the mycin family it was just the standard "stomach issues" that apparently a lot of people have with erythromycin -- it's hives, and it really limits what a doctor can do. he's never even tried a z-pack with me getting hives from two different mycins. my mom can have a bad respiratory infection and take six pills and be done with it -- and i really envy her that. anyone who walks around with a cracked tooth is a much more pain-tolerant soul than i am, i guess, unless the nerve is already dead or something. everyone told me that a root canal was a painful procedure -- bs! once he had me numbed up, all i noticed was pressure, and you never saw a happier soul than i was after that dental appointment. he gave me a script for vicoprofen for "after pain" that i gave back to him when they put the permanent crown on it. i knew it'd been hurting some before it finally broke (then it was exquisite), but i didn't realize just how bad it was really hurting until they root-canaled it and i woke up after the numb wore off, pain free. (feel free to pass on my story to anyone you know who has a dental phobia -- i wanted to kiss that dentist, and i'm happily attached!)

i appreciate the reassurance. i was able to work with my pcp to get enough pain relief until the dental office could get me an appointment, so i was okay. too bad it took a month to get scheduled for the root canal! at least they were able to save the tooth... mainly i was just wondering if the allergy list was what was causing it. i didn't even bother going to an er when i dislocated my kneecap last year -- well, i was able to walk on it after putting it back in place immediately after, so it didn't quite qualify as an emergency. (it was when my man saw me limping that he insisted i go to the doc -- i'd torn my mcl slightly.) i know especially er docs have to walk a fine line between being "dr. feelgood" and treating legitimate pain. but when i've gone in to the er for acute injury, it's felt like the docs thought i was being a wimp. (my pcp actually lodged a complaint with the er after my fall down the stairs, saying that "no doctor in his right mind would give etodolac for an asthmatic patient with an allergy to aspirin" -- but that was in college in another state.) what bothered me about the way that particular er doc handled it, though, wasn't that he said "don't come back in here for a toothache" -- he said that if i came in for any pain, he wouldn't treat it and had marked it in my chart. i felt like he saw me as a "seeker". and i couldn't for the life of me figure out why, until i started reading this board more thoroughly and saw that "long allergy list" was a sign. oh well. i *am* grateful for the small script that got me through until i could see my pcp. and i realize that's what an er is for. i just wish he'd been a bit more ... oh, i don't know.... nice. "it's my policy not to give multiple prescriptions for toothaches because it doesn't fix the problem" would have went over better than "don't come in here again for pain, we won't treat you." the nursing staff, i must say, was exceptional at that hospital. take care, and again, i don't envy any of you er nurses. i would much prefer to deal with crazies than with vegetables in every orifice.

I'm a long-term lurker, but this is my first post. I'd like to give a bit of background, and then ask a question that I hope won't be laughed at. I'm 28 years old. I'm working in the computer industry while finishing my degree, hopefully to be a psych nurse (I couldn't handle an ER after being married to a resident who was in an ER rotation while waiting for an opening for OB-GYN.) At age 19, after my mother was dxed with FMS, she wanted me to go to her rheumatologist to investigate the muscle pain and poor sleep I'd had for years. Sure enough, with 13 of the 18 tender points, I was dxed with FMS as well. (Those ones at the point of the collarbone REALLY hurt.) I was given a ton of Flexeril, which just made me sleepy, and then given Zanaflex, which actually worked without making me horribly drowsy. But at that time, I was also very overweight, on BCP, and also on thyroid meds. After I was single, I quit the BCP and my weight dropped off almost as if my magic (scared my PCP actually). Losing the weight made a huge difference in my pain levels, as apparently I also have some disc issues and you know how weight loss helps those. Anyway, have not taken any meds for FMS for six years, and while I have an occasional bad spell they're not nearly as bad as they used to be. I'm also allergic to aspirin and etodolac. (Also allergic to erythromycin, clindamycin, and a now apparently withdrawn quinolone called Raxar, but those are antibiotics.) Having five medication allergies, apparently, is a red flag for an ER. I've stopped mentioning the old FMS dx because it seems like every time I do I get really bad treatment from anywhere. My question is this. I had to go to the ER for the first time in 3 years (the last time was for an asthma attack at work, they take workplace health incidents very seriously and insisted on calling an ambulance) for a broken tooth. I mentioned my allergies. The doctor could see it was a freshly broken tooth, and did give me a prescription for eight pain pills and a referral to an oral surgeon. However, he was very abrupt with me and said that if I came back in with pain of any sort they would not treat it. I didn't mention the FMS dx from years back. Was this doctor just afraid of the DEA, or did my allergy list combined with the fact it was a toothache make him think I was a seeker? Yeah, I was seeking pain relief after the ibuprofen didn't work, but I really don't feel I was a "drug seeker" as the term is commonly used. I've never been to an ER for the pain that may be related to FMS -- the only time I've went to an ER for pain was when I sprained (and later re-sprained) an ankle and right after a car accident. The original sprain, from falling down stairs, was while I was first in college and that was when I found out I was allergic to etodolac. The resprain was five years ago. But essentially every time I've went to an ER for acute pain, I've been treated badly (in my opinion). I was never one of those patients who said 10/10, or was abusive to the nurses or doctors. What the doctor wrote, I accepted without comment and tried it to see if it worked. If the ER docs think I'm a seeker, what is the red flag they're seeing? The FMS is hardly ever mentioned, I've usually had higher than normal for me BP when I present, and I've done my best to be cooperative with any tests, etc. Or is it just standard practice to treat patients rudely who present with pain? Maybe I've had a run of bad luck with doctors, but ... I'm wondering if it's my allergy list. Any suggestions or red flags that show up in my history to you more experienced ER nurses? I appreciate you listening to such a long post. Take care, Malanya