WILTW 10/22: ENT and the Priapism

[LadyFree28, BSN, LPN, RN]

Hi everyone!

It has been an extremely busy week for me, from overtime to educational opportunities, I am exhausted!

As the days get shorter, I'm thankful for being able to work midshift, although the possibility of interesting patients and families make for an...interesting encounter-to put it mildly.

I had three days to recharge my battery, mainly because I needed the rest; I hate to be off schedule, but sometimes rest precludes the mind and what it wants.

So, what I learned this week:

Sickle Cell Disease and trazodone is a risky mix for priapism; to balance a reduction while getting my other patient ready for emergency appendectomy surgery was a balancing act in itself;

Intracaverosal Phenylephrine can help with reduction of priapism, especially in drug-induced states due to the drugs alpha-agonistic properties.

Attempting to inform a healthcare worker that a no urine production is dehydration in children and NOT urinary retention, and the constant badgering of numerous attempts to bladder scan said child and still near the end teaching is necessary can be arduous at best.

Even swallowing healed tissue from a post T&A and the subsequent blood can produce over 500 mL of ingested blood, while the pt next to you undergoing anaphylactic shock can have an infiltrate produce extravasation within five minutes of checking the IV's patency and the pulse oximeter producing a 70 percent saturation; the infiltration went down with elevation and ice packs, and I was able to get my patient to emergency surgery by wrestling the ENT surgeon who was exuberant enough to almost get my patient whiplash by crashing into a wheelchair and taking over.

I also leaned despite these interesting cases, I was able to manage complications with ease and teamwork while I maintained management of my patients.

So, what have YOU learned this week?

[nrsang97, BSN, RN]

Lady Free I have seen the phenylepherine used to treat priaprism.

As for me this week I haven't really learned much of anything. I am getting back to work after being off for a few weeks to have some hardware removed from my wirst that was irritating the tendons.

[VivaLasViejas, ASN, RN]

I learned that doggie kisses aren't really very sanitary after all. Their mouths contain E. coli and often MRSA, so if you've got any wounds on your skin you may get infected, and even if your skin is intact. Well, they do have some pretty filthy habits---one of mine eats poop!---so I guess I'm going to have to train them not to lick me anymore. I'll bet they don't catch on very quickly.

[Kitiger, RN]

I learned that doggie kisses aren't really very sanitary after all. Their mouths contain E. coli and often MRSA, so if you've got any wounds on your skin you may get infected, and even if your skin is intact. Well, they do have some pretty filthy habits---one of mine eats poop!---so I guess I'm going to have to train them not to lick me anymore. I'll bet they don't catch on very quickly.

It would be like trying to tell a grandma not to hug.

[TheCommuter, BSN, RN]

---one of mine eats poop!---

Since I no longer deliver direct patient care, my learning occurs in other aspects of the realm of healthcare...

Anyhow, I learned that the act of eating poop / fecal matter is officially termed coprophagia. The act of smearing poop is referred to as scatolia.

In addition to animals, some humans engage in these distressing behaviors such as very demented elders, a few people with profound intellectual / developmental disabilities, and the occasional infant or toddler.

Moreover, a handful of prison inmates have been known to smear their poop on their cell walls (scatolia) or throw it at the employees who staff the penitentiary. There is also a sexual paraphilia called coprophilia, in which an individual is sexually aroused by poop (read: brown showers).

Gee...I know this post became graphic all of a sudden. Sorry, folks!

[WKShadowNP, DNP, APRN]

I'm learning that the licensure process should be simplified. So many parts. Not an easy or quick sign here, pay there.

[OrganizedChaos, LVN]

Every day I miss nursing more & more. I wish I could apply to bridge program in my town now. I hope I have this motivation after my second son comes.

I am very thankful that my OBGYN has a sweet & caring nurse. I'm so emotional during this pregnancy so I'm glad she can be there to really listen to my issues & not have an attitude or think I'm crazy.

[Meeshie]

So far all I've learned this week is that my new employer has a spa membership program. As far as perks go that one is really not bad.

[nrsang97, BSN, RN]

Since I no longer deliver direct patient care, my learning occurs in other aspects of the realm of healthcare...

Anyhow, I learned that the act of eating poop / fecal matter is officially termed coprophagia. The act of smearing poop is referred to as scatolia.

In addition to animals, some humans engage in these distressing behaviors such as very demented elders, a few people with profound intellectual / developmental disabilities, and the occasional infant or toddler.

Moreover, a handful of prison inmates have been known to smear their poop on their cell walls (scatolia) or throw it at the employees who staff the penitentiary. There is also a sexual paraphilia called coprophilia, in which an individual is sexually aroused by poop (read: brown showers).

Gee...I know this post became graphic all of a sudden. Sorry, folks!

Where is that puking smiley when I need it?

[AceOfHearts<3]

I learned just how fast a QT interval can return to normal after reducing a dose of Betapace. My patient had a prolonged QT at 0700 and when I did the tele strip at 1430 the QT was within normal limits. The entire previous day the QT had been lengthened, but stable (not getting longer).

For people not familiar with Betapace (sotalol) it is an antiarrhythmic that can cause prolonged QT intervals. In my facility when initiating treatment with it an EKG must be obtained 2 hrs after a dose for the first 6 doses. I've had a patient before who was admitted just for monitoring when starting the drug. My patient this week was admitted for something unrelated but we were still closely monitoring her QT interval and were concerned because it was quite prolonged.

I also learned how slow the head of the beds seem to rise when you are afraid of a patient aspirating on vomit. I'd just lowered the bed to roll and clean a patient when she suddenly started to vomit. I got her on her side and got the bed up, but it just seemed to be much too slow during that time.

[Rose_Queen, BSN, MSN, RN]

Where is that puking smiley when I need it?

This one? :barf01:

I've learned that it is exhausting going back to work after a vacation. I need a vacation to recover from my vacation?

[aeris99]

I'm a month into my new job and I feel like I'm drowning. Today I learned that no amount of squishing down feelings will stop me from crying at work. Also the tissues turn into powerdery snow that sticks to your face.

As far as actual nursing info, dilt drips require Q2 BP checks. Which I did not know and subsequently did not perform.

Discharges can go south real fast when the patient sundowns.

I have no ability to distinguish between a drug seeking patient and one in actual pain. Because of this I treat them all as if they are in pain. This can rankle the other staff at times.

Also my time management really sucks right now.

I think I need to make an appointment with EAP. I don't have anyone to talk to about work stress that understands the pressure I'm feeling and it's really eating me up.

Tomorrows a new day. Hopefully I can avoid crying.