3/19 What I learned this week: more about employment laws than anything else

ixchel · Mar 21, 2016

I start work/orientation tomorrow & I am legitly nervous. I am super depressed & anxious. All I want to do is stay home. I haven't left the house in awhile & I don't know what is going on. I just want to be normal & have the energy to go to work!

Oh, Cheerios [emoji17]

I wish I had the right words. I do hope you have a great day tomorrow!

Farawyn · Mar 21, 2016

Cheerios always makes me LOL, for reals.

Last summer on AN was awesome. :inlove:

OrganizedChaos, LVN · Mar 21, 2016

Thank you everyone for the support. *hugs*

Last summer was pretty awesome sauce. [emoji41]

calivianya, BSN, RN · Mar 21, 2016

I've learned you guys need a witness for insulin now, and that bugs me out.

They are sensible about it at my FT job - only require witnesses in the computer for high alert IV stuff - IV insulin, IV heparin, IV dig, argatroban, tPA, that kind of stuff. They let the SQ stuff slide. My PRN requires witnesses for every type of insulin and every type of blood thinner, IV or SQ. I don't understand witnessing for SQ heparin. It's always the whole 5000 unit vial for adults - how could they think we could mess that up easily? :no:

Asterixis and fetor hepaticus can result from increased ammonia levels and, consequently, encephalopathy.

I learned last year that if you let the ammonia levels get too high, the patient will go into a grand mal seizure right before she goes straight to asystole. Last recorded ammonia level on that patient was over 1200 and we had withdrawn care. Ammonia levels are nothing to play around with. They don't talk about the whole cerebral herniation thing in nursing school (at least, they didn't in mine) because most of the time patients don't get quite that far before we treat them, but that's the end of the chain, not just encephalopathy. I have a whole new respect for how awful liver failure is after watching that patient pass. It was horrible.

Somewhat unrelated to nursing, but I learned about X inactivation this week and thought it was utterly fascinating. Having two active copies of an X chromosome in a cell would kill you. Female cells completely inactivate one of the X chromosomes and work solely off the other. It's the early embryonic cells that decide which X to use, and every cell that arises from that particular original cell will use the same X. Females are mosaics for X-linked traits. It's another one of those little things that your cells do and copy from generation to generation that's not actually part of your genes - there is no GENETIC information that tells the cells which X to pick, but the pattern is consistent in the cells arising from that original cell. It's why calico cats are always female, actually - different blocks of cells are working off different X chromosomes.

It means that although I was always taught that if a female is heterozygous for a recessive X-linked trait that she will be asymptomatic because the dominant gene will suppress the recessive one, that's not necessarily true. If she inherits an X chromosome with genes for colorblindness from her father and an X with genes for normal vision from her mother, and some of the cells in her eyes choose to express her father's X instead of her mother's, she can have varying degrees of colorblindness even though she's heterozygous for the trait. Mind = blown.

CelticGoddess, BSN, RN · Mar 21, 2016

Thank you everyone for the support. *hugs*
Last summer was pretty awesome sauce. [emoji41]

I think I love you! I love "awesome sauce". I say it too much, according to my co-workers.

Lauraingalls, BSN, RN · Mar 21, 2016

I learned that I really need to pull up my long sleeves during a birth.

Does lady parts birth goo wash out?

Young teen Mothers who have active chlamydia will believe the baby daddy when he says he didn't give it to her.

The gloves don't cover the pulled up sleeves that are now exposed arms. When you go to shove chucks under said teen chlamydia mom after birth... If you shove too far... You get chlamydia goo on your arms.

calivianya, BSN, RN · Mar 21, 2016

I learned that I really need to pull up my long sleeves during a birth.
Does lady parts birth goo wash out?
Young teen Mothers who have active chlamydia will believe the baby daddy when he says he didn't give it to her.
The gloves don't cover the pulled up sleeves that are now exposed arms. When you go to shove chucks under said teen chlamydia mom after birth... If you shove too far... You get chlamydia goo on your arms.

Oh crap. You are a better person than I am; I would have had to leave and take a shower immediately. :barf02:

lavenderskies, BSN · Mar 21, 2016

I start work/orientation tomorrow & I am legitly nervous. I am super depressed & anxious. All I want to do is stay home. I haven't left the house in awhile & I don't know what is going on. I just want to be normal & have the energy to go to work!

Chaos I'm placing a bet that once you get out of the house you'll feel better about getting out. Got the fingers crossed for you! :)

Long Term Care Columnist / Guide · Mar 21, 2016

I learned that I'm still sentimental about nursing even though my relationship with it ended badly. :)

nutella, MSN, RN · Mar 21, 2016

Ixchel - I hope that your workplace issues, whatever they are, will get worked out and that things are getting better!

I had surgery last year, had to take a 6 week FMLA, and it took HR about 2 weeks to let me know I was approved. My advise is to call HR if you have not heard from them after 1-2 weeks to make sure they have all the paperwork they need. The HR manager had told me that when the paperwork is not filled out ok, they sometimes put it to the side thinking that more stuff is coming, and in the process "forget" about it. HR will see your dx but it should not cross over to your regular manager, it is confidential information.

What I have learned this week:

Although patient-centered care and to an extend patient directed care is what we aim for, a lot of patients will be overwhelmed by the idea of making important decisions. They will say, for example, "I thought the doctor tells me what I have to do, instead I have to decide if I want a feeding tube and never eat /drink again - or not and die???".

When we want patients and their relatives to make important decisions about their goals for care we also need to support them not only with the information to make such decision but also emotional support as it can cause a lot of anxiety. For example: "I am not making a decision about a code status - I do not want to kill my mom" or similar.

People confuse palliative and hospice care a lot. Palliative care focuses on symptom control for things that we can not cure, somebody can have palliative care for years to help with symptoms of a serious illness (N/V,pain, anxiety, spiritual suffering...) . Hospice care is for end of life care when a person has an estimated life of 6 months or less left plus wants to focus on comfort as opposed to cure (no trips to the ER, doctor..). Hospice care is very appropriate for many patients at the end of life to help the pat and family through the last stage in life but, true enough, it does mean to face the idea of dying and loss - which is something we are not good with in out culture here.

The Edmonton Symptom Assessment System is a great standardized tool to assess palliative care needs in cancer patients:

http://www.npcrc.org/files/news/edmonton_symptom_assessment_scale.pdf

For non cancer patients I use the Palliative Performance Scale:

Palliative Performance Scale

People who do not qualify for insurance and years ago received care and medication under "free care" are now insured under Health Safety Net, which will pay for basics and does not depend on immigration status.

I did one visit to the college my oldest child will super most likely attend (99.5% sure) and I like the college very much. Also, I really like how young people get engaged in their future. Once I am done with graduate school I would like to teach one day a week or some hours in the evening during the week, or take students in my department ( we do not take students right now as we are small and developing but I can see that along the road..).

OyWithThePoodles, RN · Mar 21, 2016

This week I have learned:

* I need to bring my hospital balls to the school. Figuratively speaking. While on my home visit, I was far too nice to the parent who seemingly COULDN'T (I sooo wanted to say could) care less. At the hospital that ish wouldn't have flown.

* How easily we become so accustomed to doing something...I helped teach a CPR/first aid course and I had to stop and think about how I take my gloves off. I am so used to doing it (the correct way btw), that I had to slow myself down and think about it to show others.

* I wish my md would have talked me out of a tubal, and pushed an IUD instead. I know my body cannot handle another baby, I know this. But the thought that this baby being my last is absolutely ripping my heart out. It hurts more than anyone knows. (In tears as I type) I think I would've done better if the decision was made after the post-partum period when my hormones are back to normal.

* My little brother will come to school the next day and tell everyone that his Sissy is a hero after we were the first to arrive to a car-wreck. Thanks kid, just glad the little old man was okay. ALSO!! If you use the gloves out of your first aid kit to dye a shirt, replace them, because you WILL need them.

OrganizedChaos, LVN · Mar 21, 2016

I didn't go to orientation. *sigh* This was my last try at a job. Now I am going to apply for disability because it is obvious I can't hold down a job.