I have two chronic conditions that have been an incredible hassle over recent weeks. One of them has been a huge part of my recent employment issues (epilepsy, which rears its stupid, ugly face when I lack adequate sleep, though that wasn't everything at work). Both (epilepsy and spondylolisthesis) have made this week the suck!
What have I learned?
1. Don't go to Disney if you have any type of ortho or neuro issue that restricts your ability to ride almost everything. You'll be in pain and watching your vacation fly by from the sidelines.
2. If your inlaws are selfish jerks, do not tell them how your handicapped arm band works. They WILL hijack your pass (and your entire days making you unable to do anything you want) and treat you like ess when you shut that crap down because you're tired of sitting around waiting for a turn to use it (never happened until the end).
3. It makes my blood boil that people do NOT understand chronic medical issues, or at least open their minds to the fact that they may not understand what they are seeing. Instead, people go straight to, "I bet it's her meds for her back. That is not what epilepsy looks like." No, I didn't learn this one. I was reminded of it. My husband loved being called a liar. PEOPLE! EPILEPSY LOOKS LIKE "EPILEPSY" LESS THAN IT DOESN'T.
4. Girl Child has anxiety. This rips my heart out. My husband needs some coaching on this, but so far he's done okay.
5. Winning a fitbit workweek challenge against people who regularly go >20k is the best feat ever consider all the stuff above going on. I had a 28k day! Nurses, get a pedometer (if you don't have one) and challenge yourselves!
I have so few health/nursey (somewhat) things to add. Mostly I share this to help others when working with patients who share similar conditions. Lived experiences can sometimes trump textbook learning. So, ditch the inlaws early, get plenty of medicine, get benzos in case of persistent seizure episodes, and going to Disney right before spinal fusion is stupid. Wait a year.
I hope you all have had great weeks! I have not kept up at all.
A tPA must be administered within 3 hrs of the onset of stroke symptoms to be effective.
The AHA is actually saying this window can be extended to 4.5 hours since symptom onset at discretion of the physician :) Just a cool little tidbit. I know they teach us 3 hours but part of ASLS is now to know 3 hours (or up to 4.5 at MD discretion).
An update from me... It is possible a resolution for employment stuff is coming my way in the next day or two. This situation is just too damn complicated. Anyway, today I have so far learned little about that, but hope to learn something later.
My spouse has learned today what my preferences are if I experience severe post op complications.
I have learned its hard to talk about that stuff without being matter of fact, and I forget I need to soften some things for him.
I think my spouse has just learned that the immediate risks at this time may actually outweigh the immediate benefit, but that the long term benefit outweighs the long term risks. This feels much scarier to both of us. 7 more days.
I have learned just how much I wish surgery could be my only worry right now. Honest to god, I do not know how I'm going to get through these coming days.
I have love and gratitude for all of you. The chatter in these threads keeps me coming back, and that is something I've needed.
My spouse has learned today what my preferences are if I experience severe post op complications.
I have learned its hard to talk about that stuff without being matter of fact, and I forget I need to soften some things for him.
I think my spouse has just learned that the immediate risks at this time may actually outweigh the immediate benefit, but that the long term benefit outweighs the long term risks. This feels much scarier to both of us. 7 more days.
I have learned just how much I wish surgery could be my only worry right now. Honest to god, I do not know how I'm going to get through these coming days.
-hugs-
I think being an informed medical professional makes the prospect of surgery much more terrifying than it is for the general population. They don't see the complications of surgery day in and day out, so while we do inform them of the risks I think that often times these risks are less "real" to them than they are to us.
I had to have a pretty significant surgery in November and honestly I was terrified. I also struggled with my communication of my wishes coming across to family as harsh because I too was very matter of fact about it.
I'm not sure what kind of surgery you're having, but many hugs and prayers for you. When I went in preop my HR was in the 110s, and I'm not normally an anxious person. They had to give me some Versed prior to actually taking me in. It's just scary to be on the other side of the bedrails. I can totally relate. I also felt like the anxiety got worse and worse in the week leading up to the surgery, just because of the reality of it all being so close.
If its any help, my surgery went well (even though it took almost double their initial predicted time on the table) and my recovery has been remarkable. I have no regrets :)
5. Winning a fitbit workweek challenge against people who regularly go >20k is the best feat ever consider all the stuff above going on. I had a 28k day! Nurses, get a pedometer (if you don't have one) and challenge yourselves!
The fitbit challenges are so much fun... My group of friends are so incredibly competitive so it can be dangerous too.
If you are not motivated (me) but have been in the past (I'm not a total slug) does it help motivate?
$$$ is tight. I want one, not sure if I want to for the money for it.
I'm pretty much the same (used to be skinny, athletic, blah blah, put on the happy marriage pounds and got lazy) and I found it super motivating. There have been so many days that I look at my steps, realize they're low for the day, and it gets me to walk when I definitely would not have. The competitions are definitely awesome too for motivation.
Oh, to keep on topic... This week I learned that my ability to be focused and study has definitely slipped since nursing school. I'm trying to prepare for the CCRN and can always find 4728373 things to do when I should be studying.
I learned that it doesn't matter if you are a new nurse....there are seasoned nurses that don't want you to succeed. I wish they would remember the time when they were new nurses.
ixchel, sorry to hear that you have had such a rough time and I hope your surgery and recovery goes well.
Count me in as one with a crappy week. Last night, my emailed my resignation in to my DON to be effective on May 7. I have been in this LTC for a year and things just get worse. I am of the age, where I don't need to take all this crap and drama. I had asked to work on just my weekends. I have already worked more this month than those 4 days. Yes, I was trying to be nice and help out. Had to call in sick yesterday and boy did I get reamed by one of the other nurses. Not my fault he couldn't say NO. I love my residents, but don't like so many other things about my job, like the administration. I am having quite the anxiety moments this week. Been able to avoid anti anxiety meds, but not sure how much longer that will last.
I have signed on with an Agency for agency nursing. Haven't been able to take shifts due to my work schedule and my personal life. That will change now. Some of the closer places are in the state north which is not a compact state so am sending for my endorsement there so I can take those shifts.
I am just so tired and exhausted and life is too short to deal with some of the stuff I have had to deal with.
Now, I need to figure out how to convince my husband into buying a condo down in southern Texas on the beach.
I learned that the normal range for ICP is 0-15 mmHg. If it's >20 mmHg, it's time to call doc.
Doll's eyes is really creepy and indicates severe brain damage. It's usually from trauma or shaken baby syndrome.
You have to keep a pt up for 24 hrs before an EEG to elicit seizure activity.
Gum hyperplasia is a common effect of anticonvulsants.
A tPA must be administered within 3 hrs of the onset of stroke symptoms to be effective.
A carotid endarterectomy is when the carotid artery is surgically opened and/or cleaned to reduce stroke risk.
You are speaking my language now!
For an awake and asleep EEG, you will stay up 24 hrs and will not be allowed stimulants for an ordered number of hours prior to the test. You will be video recorded following prompts by the technician to essentially hyperventilate, stare at strobes, and then sleep for a short while.
Preparation for that includes not washing hair prior, and you get this horrible goop smeared on your head to stick the electrodes on. The electrodes will look at every key area of the brain and will indicate the exact area of the brain affected.
Of note (and something I never knew until recently) - even if a person is on neuroleptics, the brain will show epileptiform activity. Unfortunately, if there is none, it isn't a clear cut diagnostic negative. It simply means no activity was present at that time. This can be incredibly frustrating for those with undiagnosed focal seizures.
I didn't know that about gum hyperplasia. Ick!
Are you sure about 3 hours on tPa? Double check it. I think the current evidence sits at 4.5. The American Heart Association's "Get with the guidelines" for acute stroke management. Three would be awesome, of course, but 4.5 should be the limit. If you find this to be true, share it discreetly to your professor. EBP should be presented in the classroom, even (especially?) in NCLEX world.
I was saving this for the coming week's thread but I learned last night that the NFL denied vehemently the chronic traumatic encephalopathy that football players experienced. I watched whatever the movie is called regarding the story of it. The whole time I was watching, I assumed the story took place decades ago. DUDE! It was THIS decade! These players essentially spend their youths and careers repeatedly getting shaken baby syndrome. DECADES! EVERY GAME! How in the world cam anyone plausibly deny that?!
When the cardiac surgeons do them, they're almost always awake (about 99.99%). Usually because they will be returning in a few days for a CABG and are very high risk. They're sedated but still able to follow commands (we put a small fluid bag in their hand connected to a pressure transducer and ask them to squeeze it periodically to ensure blood flow to that side of the brain) and have a regional block done. Also have local on the field in case it's needed in addition to the block.
When the vascular surgeons do them, it's typically the lower risk patients and they will more often than not be asleep.
General anesthesia is always a backup plan if needed.
*disclaimer: my experience at my facility
Thank you for sharing this. We only have vascular and interventional cardio, no CT surgery.
MedicFireRN
186 Posts
The AHA is actually saying this window can be extended to 4.5 hours since symptom onset at discretion of the physician :) Just a cool little tidbit. I know they teach us 3 hours but part of ASLS is now to know 3 hours (or up to 4.5 at MD discretion).