WILTW 9/19/16: Dystonic Tasks and Masks

[LadyFree28, BSN, LPN, RN]

This week's What I Learned This Week (for those newbies who may have discovered this thread)

is brought to you by good tidings and cheer!

For those thinking it's too early to proclaim such thoughts, although in Britain the Christmas season about to begin; Idiscovered this last year when my American "culture" opined that it was too "early for Christmas when a wonderful merchant during our pleasant exchange informed me it was "only 50 days until Christmas" and complained that the decorations on

Oxford Street were going up "late".

For those Christmas-philes or, whovilians that are ready for such action, I am discussing a totally different nursing season-high season in a

Level-I Trauma Pedi ED.

It's the beginning of the school season-cue the auto vs. peds, falls from playing "hooky", experimentation with spice, subaxone, and possibly kitty litter, alcohol, and whatever is within a child's two eyes; the droves coming in after the games they are interested in (for home or fantasy interest) are over to attend to their child's ailment, as well as the asthmatic, sickle celll, chemo, strep and flu cases with a side of social issues-the ROPAs and the ROSAs and anything weird in between. Although it is rainy and a Monday night game is anticipating people to stay home, I am preparing to not get cancelled for this extra shift-''tis the season!

So, as I sit here after getting my teeth cleaned and not stomping anyone to the ground (my dentist knows my phobia), and done with my lab work to see if I am cleared to start trying to have a baby-who will avoid and ED at all cost unless ACTUAL emergencies-and my neurology appointment, what I learned this week:

1. I relearned about that metoclopermide can cause acute dystonia, and while diphenhydramine can work wonders, it doesn't help to have an anticholenergic on board; it looks scary, makes people scared, though can be reversed with no lasting effects.

2. I'm getting better at chunky baby/toddler vein location and inserting at the bivalve of the vein is usually a success for IV access.

3. That people in this day and age of Dr. Google, still believes that the oral and genital system are totally separate from the rest of the body systems, despite the similarities in tissue and cell makeup and that they connect with most of the body.

4. That social and health/life management situations can be just as taxing with family members as with patients.

5. That Dr. Google can be useful to scare family members into action, despite have the title of "eponymous nurse" in the family.

6. That I actually miss packing for a trip; around this time last year I was preparing to hop across the pond for a much needed holiday; despite packing being

stressful to me, to have a vacation within grasp is a stress I can find comfort in.

7. That I actually WANT a vacation !!!

Although I think I can find comfort in my social calendar with upcoming food festivals, outings, concerts, and being able to

work weekends once a month (FINALLY!!!) and set my schedule, I can anticipate a vacation (or two or three) within the next year.

A Bonus: it's reassuring to know that my neurologist, who I have been with for about 4 years now and has managed my trauma pain and closely monitor my

PTSD pain symptoms along with my therapist determined I am managing and coping excellently. I have been released from therapy since the late spring, and have been doing well;

I try to stay in tune as to if I need a check in, but I'lol be premature to say my PTSD is in remission for the first time since my trauma in 2008.

So, what have YOU learned this week?

[TheCommuter, BSN, RN]

3. That people in this day and age of Dr. Google, still believes that the oral and genital system are totally separate from the rest of the body systems, despite the similarities in tissue and cell makeup and that they connect with most of the body.

The gastrointestinal tract begins at the mouth and ends at the anorectal region, yet the Google-educated people out there will attempt to shout you down if you dare to mention this fact.

I cannot stand know-it-all visitors and families...

[xoemmylouox, ASN, RN]

I realized just how much I miss Peds.. My older patient population is mostly opiate addicted, manipulative, demanding, and downright rude. I cannot wait until I am done with school. Give me some crazy parents, I'll take them over the misery of my current position.

I feel like my anxiety and depression is going into overdrive, but I am breastfeeding/pumping so I have to pretty much tough it out.

I had the experience of seeing two cardio physicians disagree on the cardiac rhythm of my patient during clinicals. If they can't agree how on what it is, how in the heck am I supposed to know?? (complex cardiac rhythms are a weakness of mine).

I got an unexpected raise at one of my PRN jobs.. I may only work 1-2 shifts every 3 months, but I'll happily take it!

[TheCommuter, BSN, RN]

...I am breastfeeding/pumping so I have to pretty much tough it out.

Since when did you have a baby? Congratulations, Emmy! :)

[nutella, MSN, RN]

Ladyfree - great that you are doing so well! I had PTSD that went into remission, flared up when I did not even thought about it 10 years ago, and went back into remission some while ago. I find it important to normalize it. People can get better - sometimes it takes more time and more work but it is definitely possible to heal in a bigger way , it happened for me. 30 years after the events that lead to PTSD stopped it is more like a faint memory.

What I learned this week is actually about health prevention!

I visited my child in college (family weekend) and learned about the "healthy campus" initiatives and what the University does to keep students healthy.

They do offer clubs like meditation, sports, and other enjoyable activities to deal with stress. But they also have programs to track activity with a pedometer, healthy nutrition, and now will be a smoke free campus. When I walked around, I found a lot of flyers on message boards that encourage students to seek help for this and that. There is also information about family planning and where to go or call if pregnancy is a worry or a person would want contraceptives. There is education about safer sex as well.

They also engage students on the weekends with activities to offer alternatives to the frat row.

I think healthy behavior and prevention is important and I have the feeling that the generation that starts college now or has started the last years is better educated about how to stay healthy than any other generation.

[Farawyn]

Good morning! I haven't learned anything yet. I am simply bumping this thread. :)

[VivaLasViejas, ASN, RN]

I learned that despite having a college education and having worked with Medicare patients on getting approval for certain medications, I don't know very much about navigating the vast system. It is a nightmare trying to choose the right plan, the right Part D program, and the right doctors and pharmacies. I have several rather large publications on this topic and have been to a counselor, but it's hard to make sense of it all. And I wonder: if I'm having such a difficult time sorting things out, what must it be like for someone without any knowledge of how the whole shebang works? As it is, I think I've gotten everything in place, but I guess I'll find out when I start using Medicare next month. Woof!

[Meeshie]

I feel like my anxiety and depression is going into overdrive, but I am breastfeeding/pumping so I have to pretty much tough it out.

You totally don't have to just tough it out. There are meds for PPA/PPD that are fully compatible with breast feeding and breast feeding goals. Seriously. Talk to a lactation consultant if you decide to go that way. You never have to just tough it through if you decide you don't want to or that it isn't what is best for your health.

[pixierose, BSN, RN]

Oh, the things I have learned this week ...

I finally figured out the differences, the whys and what's RE: isotonic/hypertonic and hypotonic IV solutions.

I learned alllllll about hematopoietic growth factors, all bazillion of them (or so it feels, I'm tired)

Oh, NETY. No no no. The nursing students currently in my clinical group are a vicious lot, to a level I've not seen... Ever. These youngin's like to cut down other students in front of others (not me ... Yet), while complaining to all who will hear them that those students will be terrible nurses, menaces to the field of health care. Yet, if one nurse kindly gives them feedback -- NETY!!!! And these students will yell THAT out to all who will hear. I can't.stand.it. They are the most spoiled, ridiculous bunch I have ever had the misfortune of being with. And I spend two 12 hour days with them .

[Lev, MSN, RN, NP]

LadyFree, so happy to hear you are doing well!

Re: the metoclopramide aka reglan - I have seen people react with extreme agitation/anxiety to reglan which is also corrected with benadryl however, I have found that this happens mostly because the medication was given too fast. I have gotten into the habit of mixing reglan in a 100ml bag of normal saline and letting it drip wide open. The patient will get the medicine within a couple minutes but will usually not have a reaction. I have done this with people who had the anxiety reaction in the past and they were fine when it was given slowly over a couple minutes.

What did I learn this week?

That I will be precepting (for the first time) an experienced nurse transferring from med-surg. Any pointers... because I have only had nursing students and a practicum student (when I worked med-surg), and paramedic students (in the ED), not an actual nurse.

[xoemmylouox, ASN, RN]

Since when did you have a baby? Congratulations, Emmy! :)

Thanks. He's a chubby happy 8 month old now.

[xoemmylouox, ASN, RN]

That I will be precepting (for the first time) an experienced nurse transferring from med-surg. Any pointers... because I have only had nursing students and a practicum student (when I worked med-surg), and paramedic students (in the ED), not an actual nurse.

See where their skills/knowledge base are/is. Go from there. I would hope they co work as more of a co-collaborator vs the typical student who needs more firm guidance. I have found either they are super eager and ready to get on their own and are willing to jump in from the get go, or they try to play dumb and ride out their orientation/training as long as possible.