February, 2006 Archive

February 25, 2006, 1:01 pm

Hot to Trot

My chances against pneumonia are great!

This guy might have a good chance against pneumonia, if that was his problem.

He looks like he’s having a massive anterior MI.

Or his wife’s meatloaf keeps repeating on him.

I think he’s having an acute anaphylactic reaction to the decor.

Who puts an ass (pardon me, I meant donkey), complete with a saddle, on their end table as a decoration?

The child will need theraputic counseling for years after this traumatic attempt at fever assessment.

hhhhhhhhhhhhhhhhhh

Do you know, when a patient tells me they think they are running a fever, I instinctively feel their forehead and then I take their temp?

I have no doubt that the first humans did the same thing. I imagine this scene, set in a pre-historic cave:

Caveman: “Feel hot!”

Cavewoman: “No. Have pain in head.”

Caveman: “Not that. Skin hot!”

Cavewoman: “Me feel face.” (Puts hand on forehead.) “Skin hot. Eat two of berries. Call giver of health when light comes.”

Caveman: “Me sick. No care for self. Must have all things done.”

Sorry guys, but some things never change.

hhhhhhhhhhhhhhhhhh

And now it’s time for an Emergi-disclaimer: the following is not intended to be medical advice (1) because I’m not a doctor and (2) you should always check with your child’s pediatrician for any illness or concern. There, now that that is out of the way:

Do you run into your emergency department in a state of panic because your child has an “extremely high” fever of 101 degrees?

Do you take your child’s temperature under their arm because, well, who wants to do a rectal temperature?

Do you get nauseated at the thought of taking a rectal temp?

Do you become faint when the triage nurse takes your child’s temperature and tells you that the number 40.6 centigrade is actually 105 degrees?

Are you concerned when your child’s temperature does not “break” after a dose of Tylenol?

Are you amazed when the temperature comes back to its pre-Tylenol level approximately four hours after the last dose?

What, you say? You can give ibuprofen for fever?

Does the fact that your child even has a fever cause your pulse to race, your breathing to become labored and your anxiety level to skyrocket?

You, my friend, are suffering from acute fear of fever, or, as it has been coined in the literature I’m familiar with, “Fever Phobia”.

You are not alone.

Here are some things to keep in mind. These are things I’ve picked up regarding pediatric fevers in the ER and during my stint as an advice nurse in a pediatric clinic.

  • Fevers are not dangerous.
    • They are the body’s way of fighting off an infection, either viral or bacterial.
    • Fevers are more likely to be bacterial and should definitely be evaluated if
      • They last longer than three days.
      • They go over 105 degrees.
    • The exception to the rule: fevers in any child under 8 weeks old should be evaluated immediately by a physician.
  • The height of the fever is not as important as how the child is acting/looking.
  • Febrile seizures are the scariest things you will ever see as a parent.
    • They are also harmless.
    • Usually it is related to how fast the fever rises or drops.
    • They will stop on their own.
      • Turn your child on their side to allow any secretions to drain.
      • Protect them from injuring themselves on surrounding items.
    • The child should be evaluated immediately after the first febrile seizure.
      • The doctor will need to confirm that the seizure was truly due to the fever and not an underlying medical condition.
      • Discuss with your pediatrician what steps you should take if your child has repeated febrile seizures.
  • Both acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) can be used for fever.
    • There is some difference of opinion on whether or not both medications can be used together, i.e. alternated. Ask your pediatrician what they prefer you to use.
    • Pediatric dosages are based on weight. The dose your child took six months ago will not be the correct dose today. If your child’s weight is not listed on the bottle, call your pediatrician or an advice line to get the correct dosage for the weight.
    • Ask your pediatrician at what age they suggest using Motrin. It has been my experience that ibuprofen is not used under six months old.
    • Expect the fever to return as the medication wears off. It will.
  • Do not wrap your child up if they have a fever.
    • Right: a diaper and light covering – just enough so they do not shiver.
    • Wrong: a diaper, two onesies, a terry-cloth one-piece with “footsies”, a sweater, a blanket-sleeper with “footsies”, a coat, a hat and a fifty pound afghan hand- crocheted by grandma. At the same time.
  • Most children with fever will not want to eat, but they will be thirsty. Fluids are important.
    • Encourage them to drink as much as they want of whatever they want.
    • Make sure the fluid has calories in it. That sounds silly to mention, but offering diet sodas will not contribute calories or nutrition.
hhhhhhhhhhhhhhhhhh

When I worked in pediatric triage, my facility used protocols written by pediatrician Barton Schmitt, MD. I have to recommend this book as one of the best books on child health that I have ever read. It is based on the same protocols we used at the clinic. I have given it as a gift at at least six baby showers. Apparently it has been updated in 2005. Here is the amazon.com link for those who are interested:

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February 23, 2006, 4:25 pm

Props To Providence Portland Medical Center

This should be interesting.

I am typing on an old Windows desktop computer and I am a die-hard Mac person.

No offense, but yuck!

The picture to the right is of Providence Portland Medical Center in Portland, Oregon. One of the top 100 hospitals in the United States.

Now I know why.

hhhhhhhhhhhhhhhhhh

I am proud to announce that my daughter has given birth to two NON-CANCEROUS ovarian dermoid cysts. I told her that she had a lot of folks she didn’t know praying for her; she gave me permission to give this update and to give her thanks to all of you who gave us “virtual” support.

Pathology reports are pending, but everything looked okay per her surgeon, and the tumor marker was within normal limits.

It’s hard to know where “nurse” ends and “mom” starts. For instance, her doctor gave a fantastic “inservice” on ovarian dermoid cysts after the surgery was over, which I found fascinating. No cancer involved. We shook hands and I walked into the elevator.

And burst into tears of relief.

I knew I was worried, guess I was more scared than I wanted to admit.

I have named the cysts Barry and Bridget.

I have asked my daughter to make sure that any future grandchildren be made of more than hair, calcium deposits and nerve endings.

She has said she will try to comply.

hhhhhhhhhhhhhhhhhh

Due to some nausea issues and an unexpected allergic reaction, we stayed the night. I was able to stay in her room with her.

This was the Taj Majal of hospitals.

  • A huge, sprawling facility that color-codes their elevators to make getting around easier.
  • A “food court” open until 0330. With Diet Pepsi!
  • An “IV” team that inspects all IVs in house every 24 hours for inflammation or infiltration and restarts prn
  • A day ratio on the med/surg floor of one RN to a max of 5 patients.
  • The names of your nurse and your CNA on a large board (not unusual, I know) that also included the name of your pain medication and the last time it was given.
  • The nursing care was impeccable.
    • Pain was addressed repeatedly and handled immediately in both Short Stay and on the med/surg floor.
    • Call bells answered within seconds.

Needless to say, I was impressed with the overall service, but the nurses were the best. They looked professional, they were compassionate, I can’t believe the speed with which everything was handled. This is how nursing should be.

If I ever move to the Portland area, this is where I’d be working.

So here is my official online “thank you” to the nurses and staff of the Short Stay surgery unit and the 3G med/surg floor of Providence Portland Medical Center. You guys rock!

hhhhhhhhhhhhhhhhhh

Speaking of rock, we made it to the room just in time to catch the last 45 minutes of “American Idol” and while my daughter slept the sleep of the narcotized, I voted my fingers raw for both Ace and the grey-haired guy. Thank god for cell phones.

And a pox on the house of the stupid network executive who decided to run the women’s figure skating competition against “American Idol”. Idiot.

Oh, and I also kept a strict tally of my daughter’s I&Os.

Hey, I’m a nurse. I’ve got to do something.

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February 20, 2006, 10:21 pm

There’s No Test At Grand Rounds!

Obviously the guy in the first row on the right did not study.

I bet he hates the guy to his right, who probably studied non-stop for five months and has no social skills to show for it.

The guy in the middle of the second row looks like Tony Soprano got him into medical school.

But there is no test for this week’s Grand Rounds over at Dr. Andy’s place.

Just a lotta good linkin’ and a ton o’good information.

I’ll be reading it from Portland tomorrow night, from a desktop computer with a dial-up modem.

It will feel just like the old days when I had to sit at the desk to do any computer work.

Now, I just take my laptop anywhere I want with my wireless AirPort Express and cable
modem!

Better living through technology!

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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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