5/01 WILTW: Margaritas and Oral Thrush

Nurses General Nursing

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I've been asked to start the WILTW thread, and I'm more than happy to!

This has been an exciting week for me, as it was the last week of my Med/Surg I rotation. I'm trying not to feel too relieved though, because finals are next week. That being said, I will still absolutely squeeze in time to catch up on GOT.

This week I learned:

That my clinical instructor is a big ole softy. I can't believe that I thought she was super scary when the rotation first started.

That having just one year left of nursing school doesn't feel like enough time. Don't get me wrong, I feel like I've learned a ton in the one year of school I've had (and I'm more than ready to graduate so that I can get my social life back), but when I think of just how much I still don't know, I get a little worried.

That I wish I could take some patients home with me. Throughout clinical, I had nice patients, but none that really lingered in my thoughts when I went home for the day. But last week I had a patient who had already been through so much. His whole family had already been through so much. Sometimes it's hard to know just what to say, and I hope I was more helpful than I felt I was.

That I'm probably going to have a lifetime of telling family members, I'm not a doctor. You really need to talk to your doctor about that. I will probably NEVER be able to diagnose you.”

I've also learned that said family members, when you actually do give them advice (such as dietary advice), will say Oh, you're just regurgitating what you've learned in school,” and will continue to eat everything under the sun while wondering why their blood pressure isn't controlled. Why yes, I am telling you what I've learned in school, but apparently you'd rather hear that steak for every meal paired with a margarita is the best possible chance for survival.

That being said, I do follow the steak and margarita diet. But hey, I'm working on it.

That the best way to get a resident to like you is to empathize. Let them vent. Losing my independence is something I can hardly fathom, and I'm sure I wouldn't handle it with grace. (Like, really I'm very certain that I'll be the LOL trying to escape everyday and falling out of my wheel chair in an attempt to lunge out the door). It's ok to let residents feel angry about it. It's ok let them know that, yes, it does suck, and that you'll be right around the corner when they're ready for help.

But it's not ok if they scratch you. Or bite you. Oh swear at you. We still need some limits.

That I will never ever forget to do an oral assessment on my patients. This is the second time I've shined a penlight in there and found a massive case of oral thrush.

On that note, I'm also very glad I'm not a dentist or dental hygienist. I'll wipe all the butts in the world, but don't bring that mouth any closer to me.

But what's grosser than the grossest mouth? Maggots. I was not pleased to learn that maggots are still being used for wound debridement. That...is my limit.

So what did you learn?

I have a meeting this morning with my adviser. Hopefully she has some ideas. I'm not really sure what other viable options I have.

I contacted my professor about extra credit. I'm not holding my breath though. She's turned down a few other people who had asked about it already.

let us know if anything changes! One little point... Sheesh.

The meeting went just about how I thought it would. I was told to just wait and continue studying the things I am weak in.

There is a small glimmer of hope that I may still be able to pass and graduate. I'll update once I hear something. Until then I'll be eyeballs deep in my textbooks.

Specializes in Adult MICU/SICU.

Farawyn RN: Oh YES!!!! :) :) :)

Specializes in Adult MICU/SICU.
NOOOOOOOOOOO!!!

Oh YES!!!

Specializes in critical care.

I have been fighting with the laptop all day just to get the what I learned this week posted for this week. I'm going to switch back to using my iPad to write it up, and hopefully I'll have it up tonight.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.

aeris99 I want to give you the biggest hug ever. Don't give up, we are all here for you.

Specializes in ICU.

Never heard the word hetastarch until today and apparantly NCLEX likes to ask questions about it.

?

I haven't ever seen it used, I've only seen albumin, but have been told that it's a good alternative for some patients BUT:

I've been taught that hetastarch is really good after paracentesis. If a large amount of fluid is removed, it's important to use some sort of colloid afterwards. Basically you want to keep fluid in the vasculature as much as possible, so the colloid creates oncotic pressure and holds the fluid there (theoretically). If you don't use a colloid, then all the fluid is gonna want to leave the vasculature and third space right back in to the peritoneum, the patient is gonna get hypo colonic (potentially even hypovolemic shock) and then you've got bigger fish to fry.

That being said, I've only seen albumin used and I don't always see it actually work, but there's a real world example of how one might use hetastarch.

And on the note of the albumin not working and the ascites just comes right back, according to the lecturer I learned this from,that's why diet and medications are far more successful at managing these liver disease patients-- the problem is compliance with the regimen. Getting your belly tapped and going home to eat whatever you want, that's way easier.

Specializes in ICU.
We had someone sent us who had been hyperventilating for hours. Came to the floor, no intubation, not one but two doctors didn't question this. No ABGs, no intubation... Real head scratcher. First thing we did was get ABGs. CO2 was 5. Off to the unit he went. Some things just leave you wondering - what the Samwise Gamgee were these people smoking?!

What was the pH with a CO2 of 5?!

Specializes in critical care.
What was the pH with a CO2 of 5?!

If I recall, it was only like, 7.5??? CO2 is the one number that I remember specifically because it was so shocking. His bicarb was crazy high. We got him stable on a vent and transferred him out because he'd been a patient at Hopkins for years for the condition his numbers were secondary to.

What I learned this week, a Narcan drip works for a Clonidine overdose. Who knew?

Specializes in critical care.
What I learned this week, a Narcan drip works for a Clonidine overdose. Who knew?

I thought you were just kidding. That's interesting! It looks like narcan has additional CNS stimulation properties that are helpful in combating CNS depression brought on by the clonidine toxicity. Thank you for sharing! I'm going to put this in the new week's thread.

But what's grosser than the grossest mouth? Maggots. I was not pleased to learn that maggots are still being used for wound debridement. That...is my limit.

So what did you learn?

Gi bleeds. They stink pretty bad. You need a whole lot of maggots to put of a stench like that. Unfortunately I've smelled that amount of maggots. They aren't just for therapy. In the ED I've seen enough maggots that they really don't bother me too much. You would be shocked at the amount of people that come in for maggots.

I've seen some pretty stellar abscesses as well. Surgery team comes in to assess one, pushes on it, and it drains. Some people come in with HUGE abscesses. When it all drains, it stinks.

Guts, brain matter, feces, blood, and vomit. None of that is an issue. Throw it away, or stuff it back.

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