August, 2007 Archive

August 17, 2007, 4:36 pm

Looking For Stress in All the Wrong Places

apple

There is a lot going on in this ad, but what isn’t going on is communication!

The doctor is talking vitamins but is ready to incise and drain an apple.

He isn’t even looking at the patient…

…who isn’t even listening!

I guess the way to a patient’s heart is not holding up a piece of fruit and shouting “VITAMINS!”

Something tells me the guy-with-the-hat is a lost cause anyway.

He is too busy thinking about the twelve-inch juicy porterhouse steak, fried potatoes and buttered green beans he’s going to have for dinner!

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They took away our internet access at work.

Not sure why. It was house-wide, not just the ER.

It was sure hard for the doc to look up a drug yesterday, he had to actually call a pharmacy at 0230 for the information.

I seem to remember looking stuff up in books.

I’ve use the ER computers to download detailed diabetes information in Spanish, or more thorough information on various diseases for my patients.

Okay. On the occasional slow night a Zuma game (or two) might have occurred.

Not that I ever participated.

FYI: don’t learn about Zuma, don’t download Zuma and don’t play Zuma. I downloaded it at home and it is so completely addicting it is scary.

Yes, it is that good bad.

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I know patients use the internet to look up health information. It can be a great resource for them.

It can also scare the hell out of them.

*****

The triage patient says “I looked it up on the internet, and….”

A lightening bolt of dread strikes the heart.

You see, it is never “I looked it up on the internet and was highly reassured that it is not serious.”

It’s “I looked it up on the internet and I’m dying of liver cancer.”

I did not make that last sentence up.

*****

You can’t fault the patients here. They have access to information and knowledge that was unheard of just ten years ago.

In fact, the amount of information available on the internet is incomprehensible.

Ay, there’s the rub.

Patients have access to the information.

What they lack is context.

That lack of context leads to unnecessary anxiety and often an unnecessary emergency department visit.

*****

Rectal pain and some blood noted in the stool. Not an unusual combination of symptoms, but ones that might lead a person to seek medical advice.

The person who sat in front of me at triage complained of those two symptoms.

A fissure from straining? Possibly. A hemorrhoid? Maybe. A peri-rectal abcess?

Bingo!

No, the patient did not have a peri-rectal abscess but he thought he did. He had googled “rectal pain” and when he found peri-rectal abcess as a possible cause, he came to the ER.

No, excuse me, he ran to the ER.

I don’t fault him for coming to the ER! A peri-rectal abcess is extremely serious. He was frightened out of his wits, sitting there in the triage chair. Visibly shaking.

Seeing his fear, I asked him if he had ever had a peri-rectal abcess or knew someone who did. The answer was negative. But he knew all the potential complications of having one; he had just educated himself on the subject.

Through the internet.

*****

I did not belittle his perception of his problem. But… he didn’t have any pain right at the moment and he was sitting perfectly fine in the chair. No fever or chills. I’ve seen patients with peri-rectal abcesses and they are pretty sick, usually going to surgery right from the ER.

This guy was not sick.

His diagnosis: internal hemorrhoid.

He immediately relaxed, relieved that it was “only” a hemorrhoid.

*****

When I look up a cluster of symptoms on the internet, I don’t get anxious because I have the benefit of context – I know what I am seeing.

How scary is it to the average lay person? They gravitate to the most severe diagnosis they see on the web. They have no context, no experience to help them navigate the massive amounts of available information.

I wonder if the accompanying anxiety is worth the access to information.

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And that “patient” who thought he was dying of liver cancer?

It wasn’t a patient. It was my husband. He runs a bilirubin that is slightly above normal and decided to look it up.

He doesn’t have liver cancer.

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August 14, 2007, 12:59 pm

It’s the Sudden Onset of Grand Rounds!

kiddocs

Suddenly it’s Tuesday and time for Grand Rounds!

It is “theme week” over at Med Journal Watch as Christian hosts the first GR edition to come from Switzerland.

The theme was “sudden change” and the medical blogosphere suddenly came up with many interesting topics encompassing the theme. Emergiblog is proud to be included.

(And I am proud I was able to spell “Switzerland” without looking it up. Watch out world, my brain is functioning today!!!!)

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Occasionally I will look beyond the medical blogosphere and find a post on another site that I have to share!

I stumbled upon the “HomeBizBlogger” while perusing all the carnivals over at Blog Carnival. Eve Lester, owner and proprietor of HomeBizBlogger runs the “Carnival of Blogging Success“.

This was interesting because we all want to be successful bloggers, right?

This summer was one of severe blogger burn-out for me, so this post was a godsend when I found it over at Eve’s carnival.

If you read nothing else today (after Grand Rounds, of course), you must read Writing for Bloggers 101: Writing Great Content and Avoiding Blogger Burn Out, written by Peter Stern and found at Laura Young’s The Dragon Slayer’s Guide to Life.

You will immediately relax and think of twenty topics to write about.

I did.

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Okay, time for the weekly Change of Shift infomational section!

Mother Jones over at Nurse Ratched’s Place takes the helm and steers us into our next edition!

If you’re a nurse or even if you just play one on TV, we want to hear your stories!

Send submissions to motherjonesrn at yahoo dot com or, say it with me now….Blog Carnival!

Read »

August 12, 2007, 10:30 pm

Suddenly I See

kandk

We survived!

Two weddings in six weeks and we are all still sane.

This is a photo of my son Kendall and new daughter-in-law, Kristin.

The wedding went off yesterday without a hitch.

Well, okay, there were two hitches.

One, the priest called my son “Kelly”.

Twice.

You could pass it off as a slip of the tongue, except the priest is Kendall’s uncle!

Then, (it was a Catholic wedding mass) after “Christ has died, Christ is risen, Christ will come again”, my little four-year-old nephew loudly proclaimed…

MAYBE!

Already debating theology at the age of four…

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This summer encompassed three family weddings, a funeral and a milestone birthday.

It was a summer of multiple sudden changes.

*****

In wracking my brain for a topic to cover this week’s Grand Rounds theme of “sudden change”, I realized that I deal with it every single day.

What does the child who suddenly spikes a fever have in common with the thirty-four year old who blows a cerebral aneurysm while standing in the mall? How is the sixty-year-old who develops chest pain on the golf course related to the twenty-four year old who lacerates their left index finger slicing a tomato?

They are all experiencing a health-related crisis.

Emergent or non-urgent, all are precipitated by a sudden onset or event.

A sudden change.

*****

The majority of patients who present to the emergency department do so for one of two reasons:

  • They are experiencing a sudden onset of “not feeling well. Even if their symptoms have been going on for days, something changed that made them decide to seek care.
  • They have a chronic illness but experience a sudden exacerbation of symptoms. Diabetes. Chronic pain. COPD. Ulcerative colitis. The patients handle their symptoms on a day-to-day basis, but sometimes the intensity of the symptoms will suddenly overwhelm their ability to cope (or become critical) and they, too will utilize the ER.

Something has suddenly changed.

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Emergency nursing is based on helping these patients cope with these sudden symptoms through assessing both their physical and emotional status and identifying patient needs. We collaborate with the emergency physicians to meet those needs by facilitating the medical plan of care, executing appropriate nursing interventions and evaluating the patient’s responses to the those interventions.

We can take it one step farther and say that emergency nurses are responsible not only for helping patients deal with the sudden change that brought them to the emergency department, but need to be astute observers to head off those sudden changes in patients’ conditions that occur while they are in the department.

*****

Suddenly I see that emergency nursing is based on helping/supporting people through those sudden changes – through the unexpected events that bring them to our front door.

Not all of our interventions bring sudden resolution.

When patients are better able to cope – when their coping mechanisms are strengthened and supported or when they find new ways of coping with pre-exisiting conditions, we know they will do better in the long run.

And we know that we have made a difference.

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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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