April, 2007 Archive

April 3, 2007, 11:31 am

Grand Rounds: Big, Bad and Basic!

duckies

I went “quackers” over this shot!

They squeak, they float and they squirt water if you squeeze ’em too hard!

They are….well, I guess I better call them “Nurse Ducktitioners”!

I’d hate to think that this photo of these cute little toys might cause any controversy amongst my esteemed collegues!

I’m am, however,  trying to imagine what Dr. Crippen would say!

In case you’re wondering, I’m third from the left in the middle row…

*****

This bulk of nurse duckies is being used to illustrate this week’s Grand Rounds!

Keagirl went back to basics for this week’s compliation at UroStream and boy, did she get a bulk of submissions!

Old friends and folks new to Grand Rounds are there – check ’em out!

It’s gonna take a bulk load of coffee to make it through, so I better get busy reading (and drinking)!

*****

Last call for submissions for this week’s Change of Shift, here at Emergiblog.  The deadline is tomorrow night at 5 pm Pacific time for any and all nurse-written or related posts!  Click on the “Contact Me” button on the toolbar and be sure to put “Change of Shift” in the subject line.

It’s gearing up to be a great edition!

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April 2, 2007, 11:47 am

Just This Side of Elderly

shoes

“Tender Tootsies”?

It sounds like Tootsie Rolls for the dentally impaired.

But no…

…someone thought it clever to market footwear to professional women (and men!) as “Tender Tootsies”!

Oh gee, aren’t they pwetty-wittle shoes?

Give me a freakin’ break.

I don’t care if she is wearing a cap, although just judging by that this has to be a mid-’70s ad.

Nurses don’t need tender tootsies, they need freakin’ hiking boots!

I’d go through that little flat thingy with the buckle (a buckle!) in two weeks.

Oh well.

I guess it beats “Masochistic Metatarsals”…

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

We have an emergency nurse practitioner in our department now! I’m not sure whether to be excited that we are using an advanced practice RN or to be sick because I’m probably old enough to be his mother.

******

She was just this side of elderly.

A strong, solid woman.

Demented, combative and in soft wrist restraints after trying to deck a paramedic.

Alzheimers had taken her mind. Other forces had taken her hearing and most of her sight. When left alone she would curl up in a fetal position in spite of the wrist restraints and moan softly.

The nursing home papers said she was calm and cooperative. Able to feed herself. Wheelchair mostly, but some use of a walker. Someone was making rounds at 0530 and the patient was slumped forward in the bed so 911 was called.

“Slumped forward in the bed” was the actual chief complaint given for calling 911. A follow up call came in from an administrator. When I repeated it to the medics, I had to help them lift their jaws off the counter.

The patient was always combative. Uncooperative. Barely ate. Bedridden. Nearly blind and totally deaf. The antithesis of what the medics had told us in report; the diametrical opposite of the report they had been given less than half an hour before.

Of course she was combative. She couldn’t understand what was happening, she couldn’t hear us and maybe, just maybe saw us as big blurry objects.

She was also febrile which meant a full septic workup. It wouldn’t be easy. She screamed every time the blood pressure cuff would cycle, a cascade of mild cursing, heavy thrashing and lashing out at anybody or anything – staff member or side rail, it didn’t matter.

How was I supposed to get through to someone who is so locked in, physically and mentally? How do you tell them, help them to calm down, to feel safe?

Something told me to just stroke her forehead. It took a few strokes before I saw any effect but she relaxed and her moaning lessened, the thrashing died down and she looked in my direction. I had a chance to do that twice, in between drawing labs and blood cultures before the change of shift, with the same result.

When I left, it was taking four staff members to hold the patient down for a straight cath. God only knows what was going on in her mind.

I hope someone remembered to stroke her forehead when it was over.

*****

He was just this side of elderly.

Huge man. Someone had dialed 911 and he was found in the wee hours of a weekend morning sleeping in a park bathroom during a torrential rainstorm.

Now who was hanging around a park bathroom in the wee hours of a weekend morning that would have found this guy and dialed 911? Never mind, I thought. You don’t want to know.

The medics brought him in because he wasn’t able to ambulate on scene.

The patient was disheveled. It looked like his life hadn’t been an easy one.

It wasn’t. He was an alcoholic whose blood alcohol level would have qualified as general anesthesia. He was also the nicest guy and the most polite man I had met in a while. Turns out his drug of choice was vodka and he dialed 911 himself for help.

Said he hadn’t eaten in awhile so we offered him our “gourmet” box lunch with a few extra juices per his request.

I was helping him set up his snack when I realized the pungent aroma in the room was that nausea-producing concoction of a body oozing ETOH from every pore combined with the layered odor of multiple urinations.

He wasn’t drenched from the rain. He was drenched head-to-toe in urine! We pulled off the wringing wet clothing and put him in a warm gown and a few dozen blankets. He ate and he slept. Soundly. We deemed it best that he sleep the rest of the shift in the ER.

How on earth were we going to send this man home? Nothing in our spare clothing “stash” would fit this giant of a man. We’re talking a guy who would make John Wayne look like Woody Allen.

I enlisted the help of the nurses in our psych unit. They had a washer and dryer. Usually they weren’t allowed to use them at night but yes, they would make an exception for our patient.

Our tech put gloves on her hands and went through every single pocket to make sure there was nothing that could be damaged in the washer. It’s a good thing she did. We found out our patient had a job, with insurance, a driver’s license with the address the patient was too intoxicated to remember. Keys, a cellphone, an address book and the odd bill with change.

We took the clothes to the mental health unit.

When the patient woke up about an hour later, I grabbed some vital signs and told him his clothes were being washed and would be ready by the end of the shift so that he would have dry clothes to go home in.

The nursing diagnosis? “Dignity, alteration in, secondary to substance abuse resulting in poor personal hygiene and incontinence”. (I made that one up, just in case you were wondering…)

The treatment: one meal, warm blankets, a non-judgmental group of smiling faces, a good night’s sleep and a set of clean clothes made possible by the collaboration of two nursing specialties.

It may need to be repeated, prn. It’s hard to say.

All I know is as he sobered up, my patient was just as nice and polite as when he was inebriated.

I just pray he gets a handle on his alcoholism before it’s too late.

It’s a tough road.

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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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