4/23 WILTW: It turns out nurses do make the worst patients

Nurses General Nursing

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It's been a busy week for me, even though I feel like I've done very little actively. I've got a little extra bounce in my step (figuratively) since surgery and it has made me decide to get things done that I have been putting off for ages. Along the way, I've gathered some nursey lessons, some non, and I am still getting employer/employee lessons, but that was expected.

This week, I have learned...

(for my own health stuff, good to know for future patient care)

I have gratitude for the donor I received a part from. The feeling is stronger than I expected. I wish I could say thank you to the family of the cadaver I received bone from.

After a lumbar fusion, the anti-inflammatories they pry from your desperate hands (and refuse to give you anymore) will be the best possible reliever of post op pain. The second best will be muscle relaxers (skeletal muscle relaxants, not benzos).

When spinal post op pain finally reduces, it does suddenly and dramatically. What a beautiful event that is!

Due to my post op high fevers, it is really hard to shake the fear of infection. Last cefdinir was yesterday morning. Now I wait.

I wanted to be able to say that nurses DON'T make the worst patients. But, apparently during my first set of vitals on the floor, I told the CNA she was doing it wrong. And then I took everything away from her and did it myself.

It's become harder to remain appreciative and to continue to express appreciation to a person who is hyper and argumentative, and who has been home most of the days between March 6th and today. And who has a very different definition of helping. And who has no knowledge of ability beyond ABLE. Still, "appreciative" is appropriate because, overall, he's been amazing and he drops everything for me at the first hint I might ask for help. That said... I'm so glad he went in to work today! Now I'm on the lookout for "caretaker appreciation" gifts, or acts, that I am capable of right now. He's driving me nuts, but he does deserve actual gratitude.

Counseling is the best thing I've done for myself in ages.

(medical/nursing oriented directly)

A cardiac nurse who just moved floors (probably this week) to post op spines will be so bothered by the amount of pain medication available to a patient that she'll blow the patient off (in the hopes of spreading out doses enough that SHE feels more comfortable giving them). And then the patient will spend hours trying to get it back under control again. In tears. Because pain. Horrible, horrible pain.

Hemochromatosis is a malabsorption disorder in which iron levels become toxic (high, not low, in case that wasn't obvious), resulting in organs being overrun with iron. Other secondary diseases can result, which is how people usually are diagnosed. Hemochromatosis is usually not caught before damage is caused to organs (cirrhosis is typical), which will cause symptoms and lead to testing.

(And now I'm geeking out on this - are there homeostatic processes that become permanently disrupted as a result of the high iron level? Or, if not permanently, for a prolonged period of time after iron level stabilization? Oxygen level, pH regulation, CO2, what drives breathing (O2? CO2?), etc.?)

It sucks being the normal patient sandwiched between the escape artist who goes room to room insulting perfect strangers, and the lady with the curious family member who just stares in the neighboring rooms. Just keep this in mind if the normal patient prefers to keep the door closed.

In the posterior open approach to lumbar interbody fusion, the surgeon really thinks on the fly through a lot of it. They obviously have the basic expectation and steps for the procedure as pretty standard for the technique they use. But some of the details and steps of it can't even be decided on until midway through.

Related to that, I have half of an L5 vertebra. Also, the anticipated net balance of the loss of discs and bone, and the addition of hardware and cadaver bone, is + 3 mm.

(lessons in employment)

If I decide to not go back to my current/not current/current/maybe current/finally actually current job after everything I have gone through (believe me when I say it has been utter hell), *I* will be the one who looks like a jerk. I will never stop being appalled by this whole situation.

Relating to that, there is a cardiothoracic scrub nurse needed locally (not my current employer) for 4-10s per week plus call (frequent) that pays $8-9 more per hour than my current job. Its making me wonder if I really do care how good of a recommendation I keep if I jump ship. Then I remember this is my first nursing job ever and the only person who screwed up in all of this is the manager. Absolutely everyone else has had my back and has treated me well. So, now, I email my friend, my person on the "inside" who got my foot in that door without me realizing it, and tell her gracefully that I can't burn this bridge. But, I think I might when the timing is better.

(totally unrelated)

There is a show called You Live In What, and it's so cool! I'm ready to comb through the countryside for historical landmarks and abandoned warehouses.

My wallet has, in fact, been on vacation in Cape Canaveral, where they generously cut all my cards up including a $50 gas gift card I keep in there in case of emergency. It's home now. Yay. :\

All this and I know I'm forgetting stuff still! Oh, well!

What did you learn this week?

Specializes in Med nurse in med-surg., float, HH, and PDN.

Yeah, Ixchel, I DREAD shoe shopping! (And bra shopping, too).

I can't get shoes on line for several reasons. I can tell the very second I slip my foot into a shoe if the shank length isn't right for my foot, which is more often than not. It would be useless to even try to wear them if that's the case. So, they no sooner would arrive in the mail than they would have to be sent back. THAT is frustrating.

Also I don't have credit or debit cards (was forced into doing the dreaded awful bankruptcy thing 5 years ago, UGH!) And, of course, I had to learn the hard way that it isn't wise to give a company access to the checking acct via electronic check. (unless it is for paying utilities.) So, I have to wait for the moon and stars and my wallet contents to be aligned, then brace myself to go shopping.

If I were to become rich, I would have my shoes custom made!

ETA: I know some folks are very glad not to have to wear the 'old-fashioned' nursing shoes,but I used to LOVE Clinics. It's true that you had to break them in for a while before you could wear them to work for a whole shift. Once you broke them in, they wore like iron and lasted forever. But here's the thing I loved about them, they were available in 9 & 1/2 AAA with a 5-A heel. Try and get THAT size anywhere today!

I knew you didn't like Hobbits, NSIME!

I swear by Danskos. Once I had them, I never looked back.

Specializes in Med nurse in med-surg., float, HH, and PDN.
I knew you didn't like Hobbits, NSIME!

Oh, pish-tosh, Far'wyn! You can LOVE a Hobbit, but it doesn't mean you want your feet to look like their feet!

Specializes in ICU.

Dansko and Sockwell forever. That's a match made in heaven. :D

I have learned that work crush is becoming a problem for my ability to concentrate and get work done in a timely manner. Ugh, what's with all these awesome people wandering around and being distracting with their awesomeness?

On a related note, I walked out of work with a member drawn on my arm today. You know it was a good shift when your coworker tried to distract you from charting by using your arm as a canvas for badly drawn member art.

I've learned that people who use social media to shame and bully people are horrifying. Most of them wouldn't be able to say those things if they weren't able to hide behind a computer screen.

My sister and BIL asked me to be the godmother of their future children.

I've made great friends in the nursing program with classmates and instructors. I will sorely miss them when I leave.

The next 2 weeks will be hardcore NCLEX review with ATI and Kaplan. Ready to have my brain fried.

Okay, adding on more, as I'm studying for the NCLEX.

Lipid solutions in TPN contain egg yolk components, so don't administer it to pts with egg allergies.

When you change the cap or IV tubing for TPN, have the pt in Trendelenburg, with the head turned towards the opposite side of the insertion site, and use the Valsava maneuver.

If you suspect an air embolism while administering TPN, clamp the IV catheter, lay the pt on the L side in Trendelenburg so the air is trapped on the R side of the heart), notify the HCP and slap on some oxygen.

Refeeding syndrome can occur in malnourished pts (fast drops in magnesium, potassiun, and phosphate).

Regarding the member, did anyone demonstrate techniques for getting the member to un-invert for foley insertion/care? There are tricks to this that will be good to learn for future encounters with an inverted member (which you are likely to encounter many times over your career).

If you didn't get to see how you can help this, essentially you can "push" it out. We have a urologist who is mean about this. He'll punch (for lack of a better word) right above the mons pubis and the meatus will pop out just enough for him to do what he needs to. This is essentially the way we'll do things in my description, but we'll be nicer about it. [emoji5]️

If you are doing any procedures, and you are not ambidextrous, you'll need to be mindful of which hand does what. With your non-dominant hand cupped in a C shape, place the tip of your index and second finger immediately above the member and your thumb immediately below. Push "in", placing pressure inward. If my description makes no sense, what I mean is push firmly into what is probably the bladder. Then also press inward below the member. If the firm pressure simultaneously doesn't work, you make need to alternate pressing above and below the member. You should be able to get more than just the glans to come out. When you've pushed out as much as you think you'll get, hold what you are able to grip so that it doesn't invert again.

At this point, you can do any procedures. If what you're doing is a sterile procedure, you really need a second person in the room, bonus points if its a nurse, in case you end up in a precarious position requiring your helper be the one to insert a foley.

As always, professionalism is very important here. Be sure to use slightly less than gentle pressure and avoid non-medical chatting until after you are finished. This will actually increase the psychological/emotional comfort of the patient. The patient needs to feel without a doubt that you are not in any way viewing their member as a sexual organ. They may feel embarrassment over the inversion. ALTHOUGH... I say that but most men I've encountered with an inverted member have had it for a very long time and are well beyond the embarrassment they might have felt in the beginning. I've had a couple of men even joke about it.

You might also be able to find videos on youtube. I'd search and link, but (1) TOS? I'm not sure actually, and (2) I've linked legit videos involving genitalia and legit medical procedures in the past on public websites thinking I was helping, and all the pervs started showing up. Allnurses would rather stay classy, I'm sure. [emoji5]️

I did learn how to reverse the inversion. Though it did require both of us to apply pressure.

I tried to maintain my facial expression but I must have looked confused. My preceptor did manage to keep it to only a couple of snorts before stepping in to help me. It's probably a good thing that this patient was sedated and sleepy (it was late at night) because my face clearly was not in my control.

Specializes in critical care.
I did learn how to reverse the inversion. Though it did require both of us to apply pressure.

I tried to maintain my facial expression but I must have looked confused. My preceptor did manage to keep it to only a couple of snorts before stepping in to help me. It's probably a good thing that this patient was sedated and sleepy (it was late at night) because my face clearly was not in my control.

lol!!! I can only imagine! Glad you got it figured out, though! Now that you've had your awkward try, maybe your poker face will stick around for next time. [emoji4]

Dansko and Sockwell forever. That's a match made in heaven. :D

I have learned that work crush is becoming a problem for my ability to concentrate and get work done in a timely manner. Ugh, what's with all these awesome people wandering around and being distracting with their awesomeness?

On a related note, I walked out of work with a member drawn on my arm today. You know it was a good shift when your coworker tried to distract you from charting by using your arm as a canvas for badly drawn member art.

Pics or it didn't happen!

Amazon. Lots of fun colors that can coordinate, or not. I like fun, regardless of whether they coordinate. But, like I said before, I'm miniature, so I usually find stuff too long, rather than too short.

Having a broken spine, it has absolutely saved me to prevent leg and feet pain and swelling. Compression is fantastic! Don't leave home in scrubs without it!

I keep meaning to buy a petite foot, not-petite calf pair from Sock Dreams (.com). I have tiny feet and I'm tired of folding up the toes of compression socks inside my real socks. They don't have scrub colors, but I'm a rainbow stripes kind of girl anyway.

Specializes in Private Duty Pediatrics.

My problem with compression stockings is that I have a muscular, short leg. If it's wide enough, it will be 2 inches too long. The foot fits, but the leg? Never.

Specializes in critical care.
I keep meaning to buy a petite foot, not-petite calf pair from Sock Dreams (.com). I have tiny feet and I'm tired of folding up the toes of compression socks inside my real socks. They don't have scrub colors, but I'm a rainbow stripes kind of girl anyway.

I love my rainbow stripes!!

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