December, 2005 Archive

December 23, 2005, 12:15 am

‘Tis The Season For Miracles

I knew there was a reason I didn’t want to be a home health nurse.

I flunked Bathtub Fundamentals.

I was unable to differentiate between soap scum and an acute exacerbation of mold.

The primordial ooze probably started in my bathroom.

I find it amazing that scrubbing bathrooms was considered a nursing function.

I don’t even like scrubbing patients!

********************

The Christmas season is full of miraculous stories.

The Emergency Department is full of miraculous stories, too. I’ve been witness to a few of them.

I have witnessed the birth of a child from a woman who was not pregnant and had never been sexually active.

I have seen the miraculous appearance of track marks on the arms of a person who has never even thought of using drugs and has no idea how she got that awful abcess/cellulitis.

I’ll never forget the teenager whose family found him slumped over a toilet seat one holiday afternoon. They would have thought is was the flu except that he “just wasn’t himself”. He never drank. His ETOH level was .23. Truly a miracle.

A patients experiences a miraculous loss of all friends, relatives, and acquaintances when it comes time to leave the ER. A taxi voucher is their only way home and they can’t call the person who brought them to the ER because they work!

And let us not forget the miraculous methamphetamine presence in the urine tox of those who never use meth.

I’ve had patients have a miraculous onset of destitution when it comes to filling a prescription. Or maybe it’s a miraculous windfall that allowed them to purchase the alcohol and cigarettes in their paper bag.

It’s not that I’m cynical this holiday season, I’m really the least cynical person I know.

But….will someone please tell me if I have “stupid” stamped on my forehead?

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December 20, 2005, 2:23 pm

We’re Talkin’ Grand Rounds Here

Well don’t just talk about Grand Rounds!

Go read them!

This week’s “cocktail party” is over at Medpundit where the company is great and the topics are numerous.

And in celebration of this Christmas season, I will be replacing my usual cup of coffee with some holiday eggnog!

Care to join me? Grab a glass and meet me over at Medpundit’s place!

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December 15, 2005, 8:40 am

A Nursing Study: Chocolate Selection in the Emergency Department

It’s that time of year!

The breakroom table groans under the myriad of edible gifts sent in to the ER by the local doctors, the majority of them chocolate!

Whitman’s is the best box of chocolates because it has a map on the lid of what is in each section. No guessing. Nothing worse than biting into a “carmel” only to find out it’s a “creme”. Blech.

Of course, I’d still eat the chocolate around the creme.

Nurses have ingenious ways of figuring out what is inside a piece of candy. One nurse I worked with took the surgical route; I once discovered a full box of See’s candy with every piece perfectly sawed in half. Another colleague approached the problem laparoscopically; she took a 14 gauge needle and poked a hole in the bottom of each piece.

As a professional nurse, I believe in using the nursing process when choosing my selection:

  • Assessment
    • Shape – round, square, rectangular
    • Firmness
      • feel through the paper cup to maintain sterility
      • soft, hard, slight give
    • Texture – bumpy or smooth top
    • Swirly on top – big or small
    • Color – dark or milk chocolate
  • Plan
    • Eat now or later
    • Solitary or multiple bites
    • Place selections in mailbox so no one else gets them
    • Consider milk as adjunct
  • Intervention
    • Eat a small bite as a test dose
    • Take a second bite to confirm diagnosis
  • Evaluation
    • Satisfactory: consume entire specimen
    • Unsatisfactory: commence ejection into garbage and begin process with another specimen

I have pretty good success with this system.

I will say that, professionally speaking, nothing good ever comes out of a round, smooth, soft dark chocolate piece of candy that doesn’t have a swirly on the top. However…. I have been known to consume them when faced with a shortage of cocoa-based candy.

I don’t believe I’ll be facing that situation for a few more weeks, at least.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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