WILTW 10/22: ENT and the Priapism

Nurses General Nursing

Published

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?

Sorry my child grab my phone and hit post before I could finish.My question was, what is the prudent amount of time, experience, etc.. before pursuing an FNP? I've passed my Nclex, am a licensed RN, have the clinic exp, and volunteer at a free clinic. I'm drawn to the medical side rather than the nursing side.

Specializes in Pediatrics, Emergency, Trauma.
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.

(((nrsang97)))

Hope you are doing better!!!

Specializes in Pediatrics, Emergency, Trauma.
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?

Cool puking image!!!

Too bad I can't experience the after-vacation desire for a vacation this year... :down:

Specializes in Pediatrics, Emergency, Trauma.
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!

Interesting... :bookworm:

Specializes in Pediatrics, Emergency, Trauma.
Poppycat - all of that house stuff made me laugh! That stuff is why I bought new construction in 2014... but I am going through my own drama with mine because I'm putting in new countertops. Well, it's not super drama... it's just expensive. It's supposed to be my Christmas present, but it doesn't feel much like a Christmas present when it's going on MY card because I have a card still in the 0% interest phase! I will be happy once it's paid off!

I'm guessing that's a non-titrating dilt drip? I would be crapping my pants only checking a BP q2h with a critical drip... that stuff's q15min where I work. Even the healthiest people on no drips get q1h vitals, at least, on my unit. The thought of q2h vitals on anyone makes me want to whip out the puke smiley. :barf01: It's funny how different the places we all work are.

Good for you with your pain management! You're doing it the way it needs to be done. Tell your coworkers if they have a problem with your methods, they need to update their practice. Too bad that would actually make you public enemy #1, probably.

We all cry sometimes. I thought I officially had a heart of stone at this point, but I burst into tears at work three weeks ago myself right in the middle of the hallway. None of us are immune. Being human is not a bad thing. It sounds like you are doing well to me - good luck!

My own stuff:

I had a couple shifts where they started orienting me to rapid response lately, and I learned some areas of the hospital are really getting abused. Badly. I got a call for an EKG that said STEMI up on the cardiac stepdown - ended up not being a STEMI and the physician could care less, but the truly terrifying part was their staffing.

The nurse that called me said something about how she just wanted another set of eyes on it because she was so tired she couldn't think between this guy having ST elevation, her three (!!!) insulin drips, and the other patient who wanted pain medicine all the time. I about died. I asked her in a disbelieving tone, "Now HOW many patients do you have?!" And she said FIVE! Holy crap. Three stepdown patients is my idea of a terrible, horrible assignment (but I just hate stepdown patients), four is just about unimaginable... but five stepdown patients, most on critical drips? All alert and able to use the call bell?!?! Many POD 1 after open heart surgery?

...I will never complain about my assignment again. I have never had a night that bad ever. She said they were trying to get their staffing better, but there had been nights she'd had six patients. SIX stepdown patients. I had to bite my tongue to keep from telling her to make an anonymous report to the Board of Nursing... and I'm still half tempted to do it myself.

I have learned that this semester, school is really eating me alive - but I'm enjoying it!

I miss you guys. I need to come back more often.

I miss you too!!! Glad to "see" you!!!

That sounds scary...nursing ratios should be the STANDARD.

Specializes in Pediatrics, Emergency, Trauma.

Poppycat, sorry about all your house problems. It reminds me of the shows on HGTV where they start a renovation and find asbestos in the walls, knob and tube wiring, and plumbing leaks. The simple renovation suddenly becomes very complicated and expensive.

Natural gas alarms are available at hardware/home improvement stores, Amazon, etc. They cost about $50. They detect gas at levels lower than you can detect by smell, and will give an audible alarm. Please get one of these to keep you and your family safe. Since you live in a duplex, get the owner of the other unit to install one also.

Every home should have a smoke detector. If you have a source of carbon monoxide (fireplace, garage, furnace, etc.), you need a carbon monoxide detector. If you use natural gas or propane gas, you need an explosive gas detector. Everyone please make sure that you and your families are protected.

Remember that it is almost time to turn your clocks back 1 hour (i.e. Fall Back). Check your smoke/carbon monoxide/explosive gas detectors when you do and change the batteries if needed.

That concludes the Public Service Announcement.

Not nursing related but I learned it's really hard to live in a house with the gas turned off & no shower for 4 days (cue the puking smiley!). I also learned how much I hate owning a house. Last Monday (10/17) we had a furnace company come out to clean & inspect our furnace so it would be ready to run when we need it. The guy came up from the basement when he was done & told me he smelled a very faint odor of gas down there but couldn't tell where it was coming from. My husband & I didn't smell anything. I called the gas company to come check it & they found not one but 3 leaks! They shut off our gas until repairs were done. Well, the furnace guys were scheduled to come back Wednesday to replace the humidifier on the furnace so I called & asked them if they could repair the leaks. They said yes & I figured ok, no gas for about 48 hours; we'll survive.

Wednesday comes, the furnace guys come back & take a look where the gas company marked the pipes & they say, "we don't have wrenches big enough for those pipes; you'll have to call a plumber"! Went to the Yellow Pages & called 3 plumbers before I found one who could come out that day. He comes & looks over all the gas piping in the basement & says he can repair those 3 places but all the pipes are so old that other leaks are likely to occur in the process of repairing them. He said it would be less expensive to just replace all the gas pipes to begin with. Wonderful! How soon can you do it? Tomorrow morning (Thursday). Okey dokey!

As part of checking all the gas pipes, the plumber also noticed that the water main pipe running through our basement was badly corroded in one area. Wth! If this was a movie script, it would just be too unbelievable!

We live in a condo so I called our property management company hoping that maybe the water main might be their responsibility. They said it depended on where the corrosion was: before the water meter, their problem; after the meter, ours. They sent yet another plumbing company out to check it. Finally, we got a break: the corrosion is before the meter! The plumber who came out for that called our town's public works department to come look, too. The building we live in is over 70 years old. It's a duplex as are all the other buildings in our area. I will never understand why, when they were built, the village allowed the water main pipes to be run from building to building through the basements. The public works guy who came out just shook his head! In order to fix that pipe, water has to be shut off to the entire block which requires a 5 business day notice to all residents. Therefore, repairs won't be done until Tuesday, 11/1. Hopefully the pipe won't burst & flood our basement before then!

Back to the story. Thursday morning comes & we get a call from the company that's coming to do the gas pipes. The plumber who was scheduled called in sick! Rescheduled for Friday. Remember the gas was shut off Monday!

Meantime, we put a down payment on a bathroom remodeling project back in September wherein we were having our whirlpool bathtub (which we never used) removed & a walk-in shower the length of the tub installed. Guess when it was being installed: FRIDAY! We were promised when we ordered this project that installation usually takes only one day but if, for some reason, it couldn't be done in one day, it would be finished the next day even if that was a Saturday.

So Friday morning comes & we get calls from the plumber & the shower installers saying they're on their way. Everyone descends on our house before 9 am. Let the noise begin! Six hours & $3,000 later, the gas pipes are replaced, gas company comes out & says everything is fine & turns the gas back on. Yay!

At 6:50 pm the shower installers start loading up their truck to leave. Like idiots we assume they'll be back tomorrow (Saturday). They go outside & call their boss who tells them to tell us to call the office Monday to schedule the rest of the project! Mind you, by now we have not had showers since Wednesday because there was no hot water. Ewwwww!!

We looked at them & said we were promised the job would be finished the following day. They said their boss has them scheduled on a different job Saturday so they can't come back. I got out our contract & let them read it but there was nothing they could do.

I spent the next 3 hours texting & talking with our salesman & doing an online chat with the company on their website. The salesman claimed there was nothing he could do for us so I gave up dealing with him. I told the person on the website chat I would be contacting the BBB Saturday. Lo & behold, late Saturday morning we got a call from a different installer saying he would be there between 8 & 9 Sunday morning. He said he wanted to come Saturday but he was finishing another job.

He arrived Sunday morning just before 9 & asked what had happened so we told him the whole story. He looked at the bathroom & saw all that had been done Friday & how much more there was to do & said it should have been scheduled over 2 days right from the start. He got right to work & finished just before 3. It's absolutely gorgeous but after all that hassle it should be! The most disappointing part was when he told us we couldn't use it for 24 hours. So no showers from Wednesday to Monday! I could hardly stand myself!

Did I mention that through all of this we had our 4 year old grandson at our house? He thought it was all pretty cool!

Specializes in pediatrics; PICU; NICU.
Poppycat, sorry about all your house problems. It reminds me of the shows on HGTV where they start a renovation and find asbestos in the walls, knob and tube wiring, and plumbing leaks. The simple renovation suddenly becomes very complicated and expensive.

Natural gas alarms are available at hardware/home improvement stores, Amazon, etc. They cost about $50. They detect gas at levels lower than you can detect by smell, and will give an audible alarm. Please get one of these to keep you and your family safe. Since you live in a duplex, get the owner of the other unit to install one also.

Every home should have a smoke detector. If you have a source of carbon monoxide (fireplace, garage, furnace, etc.), you need a carbon monoxide detector. If you use natural gas or propane gas, you need an explosive gas detector. Everyone please make sure that you and your families are protected.

Remember that it is almost time to turn your clocks back 1 hour (i.e. Fall Back). Check your smoke/carbon monoxide/explosive gas detectors when you do and change the batteries if needed.

That concludes the Public Service Announcement.

We already have all of those detectors. The problem was that the gas leaks were so small that the guy from the gas company said the detectors would not pick them up unless they were right at the site of the leak.

We already have all of those detectors. The problem was that the gas leaks were so small that the guy from the gas company said the detectors would not pick them up unless they were right at the site of the leak.

Good for you! I know very few people who have the explosive gas detectors.

I installed mine about 7 or 8 years ago when a 5,000 sq ft house in my home town exploded from a natural gas leak. The leak occurred about 50 ft away from the house. The gas migrated through the soil and entered the house where another utility entered the house. The family didn't smell the natural gas, because the odor that is added was absorbed by the soil. There was absolutely nothing left of the house.

I didn't know that they made natural gas detectors. When that happened, I "googled" it, and everyone I knew got one for Xmas.

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