Friday, December 31, 2010

Top 10 of 2010

Looking back over the past year, this PICU nurse feels grateful, successful, proud, educated, tired, but even a bit refreshed and relaxed (a great vacation at the end of the year will do that!).

Here are my Top 10 Moments of 2010:

10.) 2009 is over!!! It was a ROUGH year for Jon and I. We were both glad that it was over and ready for a fresh new start!! 2010 here we come!

9.) I finished 4 more quarters of grad school with a 40 GPA...more importantly, that's 4 quarters closer to becoming an Acute Care Pediatric Nurse Practitioner!!

8.) I went on some GREAT vacations (Mexico, Carolina Beach, PR, cruise)- these greatly helped to keep me walking back through those doors of the PICU and logging onto school when it just seemed too much!

7.) I have been able to care for a few patients who were not expected to live...one RSV baby, one heart transplant, one liver disease kid, etc. What a joy it is to see the day they walk out of the PICU and get to go home, healthy and smiling!!

6.) I turned another year older...and yet at least once a week still get asked by a patient or family member if I'm old enough to be a nurse!! Not so sure this is a "Top Moment" this year, but I want to remember it...I'm sure I'll greatly appreciate it in 10 or 20 years!!

5.) I started a blog and found a new passion...what a great outlet it has become for me!

4.) I had some great laughs, both in the PICU as well as in my "real life"- A few of the work related laughs can be seen here or here

3.) The little guy I've been caring for over the past 6 months is showing great developmental improvements despite living in the PICU most of his life. I am proud to say this is largely due to the committment I made to consistently care for him (wow, lot's of "c's" in that one!). It has been a true joy to be able to take care of him...but I can't wait for the day when I get to send him out those PICU doors and off to home!

2.) I have been able to make new friends and deepen friendships I already had. Friendships are essential in keeping PICU nurses sane...and friendships within the PICU are priceless. Who else would understand at the end of a long day whether it's a straight to bed vs. wine vs. martini night based solely off of the last name of the patient you cared for??

And my TOP moment of 2010:
1.) I am married to the most amazing husband in the world. While so many TV shows depict nurses feigning for the docs, it is a true joy to know that I am going home to my best friend...a man who understands very little about what I do. And this is completely to my advantage, because I can leave all of the medicine out of it, and just tell him about the emotions, the physicality of my day. And what a great listener he is!! While most of our dates this year were what we coined "Couch Dates" (AKA: catching up on tivo while I do homework), we still managed to create great memories, deepen our friendship, and fall more in love.

At the end of the day, a PICU nurse is still a nurse...but she needs to go home. No matter how long a day it is, the hospital is just not the same as home...and this PICU nurse is truly grateful for the home...the husband...that she has to go home to!!

So adios 2010....while the adventures for this PICU nurse were a roller coaster of highs and low, stresses and successes, I look forward to what 2011 has to bring!! And to the fellow PICU nurses ringing in the New Year with their "mocktail" (off-brand sprite mixed with cran-apple juice!) while putting those little ones to bed, thank you for all that you do...thank you for your dedication! Those kids are entering into a new year because you are able to keep them alive at least one more day.

Wednesday, December 22, 2010

A pleasant surprise

I work with a doctor who is notoriously known for being gruff, rude, mean, snappy, sarcastic, and tough....and SHE'S only 5' tall!!!

I say these things not talking behind her back, but in front...or rather, straight from her mouth. She knows how she comes across and is not phased by it at all. She'll admit to being this way, and in some ways is proud of it.

She has been the director of the PICU forever...and can definitely get things done her way when she wants to!!

So it came as a COMPLETE surprise to me yesterday when she gave me a gift!! A real, Christmas present, wrapped in a bag. OK, it wasn't wrapped...but it was in a bag...the one from the store...but still!

She gave me a L'Occitane beauty kit...a nice one!! (Yes, cheep-o me looked it up, and it cost $39 on the website!)
The funny part to the gift is that she has NO idea what my name is!! Yes, she went out and bought me a gift. Yes, she has worked with me for the past six years. But, NOPE, she has NO idea what my name is! She would just rather call me "nurse".

And so that's what she did! We were at the meeting I go to every Tuesday and she was passing out the gifts she brought a few of us (a book on God for the chaplan, a book on patient's near death experiences for social worker, a necklace for the child life specialist, etc). As she passed my gift, she told the woman sitting next to me, "Pass this to the extremely hard working nurse that makes these meetings run smoothly every Tuesday!"

I wanted to laugh, but I was seriously in shock, so I refrained. Not in shock that she didn't know my name....shock that she got a gift for me!!! And a little shocked that she noticed how smoothly I can run those meetings (she really doesn't give out compliments...ever!)

So I guess the Holiday spirit is in all of us....even the gruff, snappy, sarcastics docs....and the 'no name' nurses!!!

Here's to a Happy Holiday....and getting some great surprises!!! Have you received any gifts yet this year that have pleasantly (or unpleasantly!?) surprised you??

"The Day Before the Night Before Christmas"

"and I'm busy, busy, busy being good"... I think the song goes something like this.

Although I'm singing a song more like "The day before the night before another day of work..."

Being a nurse, I tend to see holidays different than most of the world. Or at least most of the working world.


Holidays don't necessarily mean time off, or time with family, or parties (unless you count the PICU potlucks). So while everyone else in the world is getting giddy over Christmas, many nurses all over the world just see it as another day to wake up early, throw on those scrubs and head out to saves people's lives!


This year, this feeling is exaggerated even more for me because I didn't do much of the traditional decorating that I normally do. Being gone 2 weeks in December and then getting into the full (psycho crazy!) swing of things with school Jan. 3rd, I didn't see the point in taking several hours to get everything up....and then several hours to get it down and back in the attic.


Plus, the husband and I decided that our gift to each other was the cruise/vaca in PR. So no gift giving, no decorations, and warm sunny weather in Dec....Christmas WHAT???


The plus side to all of this:

1.) Hello AMAZING vacation!!!! Best gift EVER!!

2.) Getting (kinda) into the holiday spirit in PR....it's just so unnatural to sing Frosty the Snowman when I'm sweating outside, but I did do it : )

3.) Not having to fight all the mall crowds to get gifts....or spend endless hours online trying to find the perfect one!

4.) Saved hours of decorating/undecorating (I can whip up my prelit 4ft tree in NO time!)

5.) PICU Christmas potluck!!! (I'm not joking...this is defintely a plus...people hook it up with the food they bring!)


So come Christmas Eve and Christmas Day, I will put on my Santa & Reindeer scrub top, make my gooey delicious crock-pot mac-n-cheese for the potluck, and celebrate this holiday PICU nursing style!

While I will miss my family, it is rewarding to know that I will be taking care of my little guy (yup, he's STILL there!!)... helping him celebrate the holiday....and doing something that many people in this world cannot do....be a nurse!

Monday, December 20, 2010

A blog Hello from.....

Sunny San Juan, Puerto Rico!!!! PICU Nurse knows how to vacation!!! And I'm loving EVERY second of it!!! It's our last day, and I'm not looking forward to going back to cold, snowy weather, but I will say I feel much more refreshed, relaxed, and rejuvinated....perfect for getting back to work and school!! Here's just a bit of what we've done over the past few weeks!!!Enjoyed some great wine, dressing up, and going to nice dinners on the cruise....
Had a FABULOUS day sail with Simplicity in St. Thomas....full of incredible food, amazing waters, and beautiful snorkling!!!
Mmmm, escargot night on the boat....one of my favorites!!!
And of course there was plenty of chillin' movie days....full of great (and plentiful!) food!!
Some gorgeous runs on the secluded beaches....heaven!

And enjoying the Christmas holiday in San Juan....what an incredible way to enjoy the holidays...especially since this PICU nurse will be celebrating with the kiddos this year!!

Hope you all are enjoying a festive and fabulous Christmas season this year....I know I am!!!

Sunday, December 5, 2010

Online Education

So having taken my entire graduate education online, I think it's safe to assume that I love learning this way. Anytime, anywhere, wearing whatever I want....it's pretty great to have this flexibility!

BUT- my opinion has slightly changed (or maybe it's just fried!) after tonight. I just finished taking the online portion of the new PALS (Pediatric Advanced Life Support) certification course. It was 5 1/2 grueling hours of simulation lab after simulation lab.

What was cool, was that as you were performing interventions (doing chest compressions, listening to lungs, ventilating, etc.) you could actually see it on the patient. If my compressions were adequate, the baby's color changed back to pink (from a lovely purple/blue). If the breaths I was giving via facemask were large enough, the baby's chest would rise well. These were the cool features.

What was not cool was if the baby was breathing, then he/she was crying constantly. So not only did you have to take an accurate history and perform a physical exam on this pseudo patient, but they would NOT stop crying!!

I considered giving some morphine to some of the kids just to get them to be quiet. But, of course, that would not allow me to pass....so I refrained!!

AND, unlike real scenarios, you could only do one thing at a time (despite there being 2 health care providers in the room!). So if I clicked the button to ask the mother a question and then had the 2nd person put an IV in, the mother wouldn't finish her answer.

Twice I forgot about this, and had the "rude" pseudo mom (how accurate can they get!?) say "I already told you!" Alrightly- guess I'm not getting that answer!!!

And the catch was when you thought you were done caring for the patient, you had to "transfer" them somewhere....to the PICU, to the general floor, to a test (CT/MRI), or stop all care (hello, I just killed my kid and am "calling it").

Once you transferred the patient, you had to tell the system whether or not you treated the patient appropriately. If you clicked "Yes, I want to continue" but did NOT accurately care for the patient, you had to successfully complete that patient scenario TWICE more!!

If you clicked "No, I would like more practice" you would get another chance to try again. But, if you happened to have done it right, you still had to do it again....only once though (assuming you did well the next time!)

Confusing I know!! Either way, it was a LOT of simulations!! And after it was done came the
written portion of the test. Which thankfully was MUCH easier than the pseudo-patients. Tomorrow I go for the live skills portion...just to show them I can not only click a button to give good compressions, but I can actually do them on my own!!! Thankfully, that's only 3 hours!!

I'm planning on enjoying the last few hours of my weekend catching up on my Grey's (which by the way, they would NEVER pass these scenarios!!!) and eating some Chinese!! Mmmm....feel good food + mindless tv = perfect treatment!! I pass!!!

Hope you all had a great weekend!!! If you've done the new online version of PALS, what do you think???

Friday, December 3, 2010

Change of Plans

Ahhh "Winter Break".... such a much needed concept in grad school! If only work would also get on board!

Either way, I have the entire month of December off from school. Being the Type-A person that I am, I wrote a list of all the things I wanted/needed to get accomplished before the insanity begins that will describe my January through August!
And then later in the day I checked my school e-mail (WHY oh WHY did I do that!?!?)...This is what I found:
Guess my advisor has completely different plans for me during this "break!" Obviously she doesn't care if my closet stays a wreck, or I finish some of the DIY projects I had planned for my casa!

Instead, she has an 8 hour video/test for me to take, along with about 800 hours of readings and preparation for upcoming projects and papers!

Nice- so much for "Ahhh, winter break!"

Guess I'll cozy up with another cup of coffee, light a candle, play some Christmas music, & get to work! It will not always be this way...in fact, next December there will be NO school at all!! Now that's a concept that will get me through!!

Despite all the work, the holidays always seem to go by so quickly...TOO quickly!! So I'm going to try and enjoy each and every moment. What are you doing to enjoy the next few holiday weeks??

Wednesday, December 1, 2010

Another Yummy Pumpkin Recipe

I am LOVING all things pumpkin right now!!! I can't get enough of it!

BUT- my body (ok, my pants!) cannot take any more high fat, high calorie meals right now! Thanksgiving just pushed me over the edge!!

So, after a great workout today, I was craving something pumpkin. What a better post-workout snack than a Pumpkin Pie Protein Shake!

I googled " pumpkin protein shake" and a bunch of recipes popped up. So I created one of my own that mixed and matched things to make it perfect for me (and the ingredients that I had on hand).

Let me tell you... It was DELICIOUS!!! It literally tasted like I was drinking pumpkin pie...but without any sugar (other than what's in milk) or the fat, or the calories!!

Here's my recipe:
-1 cup milk (I used 2% b/c that's what we had, but almond, soy, skim would all work too!)
-1/2 cup canned pumpkin
-1 scoop vanilla protein powder
-1 tsp. Pumpkin pie spice (around this much, the original recipe called for 1/2 tsp but it was NOT enough for me...so I kept adding more and more dashes)
-Stevia in the Raw added to taste (or any other sweetener you use)

Blend all ingredients together and serve over ice. If you wanted it more like a smoothie, you could add the ice right in the blender. I wanted it thicker and creamier so I just poured it right over the ice.

While the Pumpkin Cheesecake bars were amazing, it's great to enjoy something as much without ANY of the guilt (my shake: 260 calories)!! Mmmmmm!!!! Enjoy!

Christmas Spirit

The little boy that I've been taking care of since the summer is starting to go through a bit of stranger anxiety....particularly men! Every time new people walk through the door, he looks right at me with this terrified look. And then it's an all out wail!

Except you really can't hear much of anything because of his trach. His face just scrunches up really tight and the aligator tears start flowing!

But whether or not a sound comes with the wailing, he looses it...until the man leaves! It really makes the many doctors walking into his room throughout the day a joy for him : (

But yesterday was a little different!! The respiratory therapist we had typically works on the floors, not in the PICU, so I dont' really know him that well. What I do know is that he is a new face, and a man...a rather large man! I saw him coming down the hall headed into our room and thought, "Oh boy, here we go!"

But as the therapist walked in, the little guy LIT UP! Like a Christmas tree!! He was smiling from ear to ear, shaking his head (that's about all he can move because of his stenosis- see THIS post) and SO happy!

So what was with the sudden change!?!? The patient's dad was in the room, and he said "I think he thinks you're Santa Claus!" And sure enough, at the mention of Santa, the little boy went crazy! He couldn't stop smiling and doing whatever wiggling he could out of joy!

It was one of the cutest things I've ever seen! Now, I'm pretty sure the therapist didn't appreciate being called Santa, but hey, when you're a fluffy/pudgy/stout man with white hair and a long white beard, you pretty much just gotta expect it....right!?

If he wasn't so offended, I would have taken a pic to show a side by side comparison. But either way, whether or not he liked it, this respiratory therapist made the day of my little guy! And that made it all worth it to me!! Can I get a "Ho Ho HO!" : )

Sunday, November 28, 2010

What PICU nurse does when she has days off....Baking Edition!!

This year, my birthday fell on the day after Thanksgiving. Nothing like trying to pick out what kind of "Birthday Cake" you want when you know you'll be overstuffed for weeks after all that turkey, stuffing, sweet potatoe casseroles, mashed potatoes, etc. etc. etc.!


But this year I picked a GOOD one (thanks to the very enticing picture on my betty crocker calender)!! With a few modifications I'll be bringing this one to holiday or fall parties for years to come! It was super easy to make (which is saying a lot coming from me!) and turned out Oh SO DELICIOUS!! Give it a try and let me know what you think!

Pumpkin Cheesecake Bars (ingredients you'll need):
Cookie Base- 1 pouch Betty Crocker oatmeal cookie mix (1 lb 1.5 oz)
1/2 cup crushed gingersnap cookie
1/2 cup coarsely chopped pecans
1/2 cup cold butter or margarine

Filling- 2 packages (8 oz each) cream cheese, softened
1 cup sugar
1 cup canned pumpkin (not pumpkin pie mix)
2 tablespoons all-purposeful flour
1 tablespoon pumpkin pie spice
2 tablespoons whipping cream
2 eggs

Toppings- 1/3 cup chocolate topping
1/3 caramel topping

Directions:
1.) Heat oven to 350F. In large bowel, stir together cookie mix, crushed cookies & pecans. Cut in butter until mixture is crumbly. Reserve 1 cup mixture for topping. Press remaining mixture in bottom of ungreased 13 x9 in. pan. Bake 10 minutes. Cool 10 minutes.

*Yes, PICU Nurse has one crazy sister!

2.) Meanwhile in large bowl, beat cream cheese and sugar with electric mixer on medium speed until smooth. Add remaining filling ingredients; beat until well blended. Pour over warm cookie base. Sprinkle with reserved topping.

3.) Bake 35-40 minutes or until center is set. Cool 30 minutes. Refrigerate for 2 hours or until chilled.
4.) Before serving, drizzle with chocolate and caramel toppings. Cut into bars. Store covered in refrigerator.

*The finished product- ready to eat...along with chocolate birthday cake (thank you grammy!) and ice cream of course! hello dessert!!

*Next time I do this (and there WILL be a next time with this one!), here is what I'll change:

-Prepare in pie tin, or round cake pan. I didn't care for eating the bar (you couldn't use your hands anyways!)...I want this as a slice of cheesecake with a delicious crumbly crust instead!

-Double the pumpkin pie spice...once cooled, the pumpkin flavor was a bit too mellow for me

-Just drizzle caramel on top...the chocolate seemed to overpower the pumpkin flavor I love so much

Thursday, November 25, 2010

Happy Thanksgiving!!!

Happy Thanksgiving...and a VERY special Happy Thanksgiving to the wonderful, amazing nurses working in the PICU today!!!

While my job is extremely rewarding, it also comes with working holidays, so on the ones I have off, I am extremely grateful!

With that in mind, today I reflect on what I have to be grateful for- PICU nurse style : )

Top 10 Things PICU Nurse is Grateful For:

10.) I'm grateful that I work in a place that offers free 10 minute chair massages every couple weeks to the nurses...umm, yup that certainly helps the shift!

9.) I'm grateful for a desensitized sense of smell that comes over time...it certainly makes all the poop, vomit, and blood (and other unknown bodily fluids at times!) I handle so much less disgusting!

8.) I'm grateful that I have my own public announcing system right within work...hey, working with almost 200 women makes the messages get around quick : )

7.) I'm grateful that I work for a hospital where the docs (most of them, anyways!) truly respect my opinion on MY patients!! They realize I'm at the bedside WAY (WAY!!) more than them and know my patient better than anyone else!

6.) I'm grateful when it's NOT my holiday to work....grateful for an alternating holiday schedule!

5.) I'm grateful for the patients that do such absurb, quacky, out of this world things...things that we can only laugh about!! It keeps us on our toes, and definitely keeps us laughing!

4.) I'm grateful for the shifts that I can actually eat a quick breakfast, lunch and dinner...and pee!! What a concept!!

3.) I'm grateful for the families that express their gratitude...few and far between at times, but it makes doing what we do SO worth it!! AND even more grateful for the amazing family I've been caring for recently who even remembered my birthday...Amazing (post will come with the super cute card they gave me)!

2.) I'm grateful when I leave work and my SUPER sick patient has lived through the day again, largely because of the care that I've provided!!

1.) I'm grateful to be able to say that I'm a PICU nurse...what a rewarding, exhausting, fun, emotional, satisfying career!!! I truly am blessed!!

I meant to take a picture of myself after my last shift Tuesday night....it would show you the INCREDIBLE difference of PICU nurse after working a bunch in a row & PICU nurse truly enjoying the time off and the holiday with family. BUT- since I couldn't get out of the hospital faster, I forgot about it. So I leave you with a relaxed PICU nurse at Grammy's house, thoroughly enjoying my time off! Doesn't get much better than family, laughter, wine, football, & blogging! Ahhh.....


Saturday, November 20, 2010

Scheduling....On MY Terms : )

Yesterday morning I woke up and had fully planned to take advantage of the Friday off....getting a great workout in with a BFF, a massage, catching up some great new projects I have planned for the house!!!

I even posted this status on FB: "trying to suck every last minute of having a day off today before working 4 in a row...in nurses language = AGGHHH!!!!"

And then the phone call came (in the parking lot of the gym, nonetheless!). Whenever I see my work number on my cell, I kinda cringe! So I decided to let it go to voicemail in case it was something I needed to consider first! And it was quite intriguing.

It went something like this: "PICU Nurse, this is XXX manager- wanted to see if you could come in today...ANY time today...for any 12 hours...you can make them. AND I'll take you off tomorrow!"

Hmmm, come in Friday on MY terms....and get off Saturday!? Which also conveniently breaks up my 4 days in a row (hello, waking up at 5 am...standing on feet for 13 hours, and getting home at 9pm 4 days in a row...NOT fun!)

So I called back and made a deal...I would come in around 1 ("1-ish" were my exact words- hey if it's on MY terms, I'm not promising anything too specific!! These opportunities do not come along frequently!)

BUT I would NOT be staying for a 12 hour shift....I could stay until 11pm (which is the normal time a shift ends anyways). And of course, I would not be coming in Saturday to make up the 2 hours that I'd be missing.

In no less than 0.0001 seconds, my manager said, DONE!!

So I got my workout in (but had to cancel my massage...boo!) and then headed off to work!

Now anytime PICU nurses are called in extra (especially when it means we are taken off a weekend shift!) you can only expect BAD things!!! Our census and acuity would be HIGH!!! Our staffing LOW LOW LOW!!!!

But coming into it with the mindset that it's just gonna be bad always helps!! Helps me to take a deep breath and know that I can only do the work of one PICU nurse. And hey, if the situation always gets too bad, not enough hands, patient not doing so well, the code button is bright green in every room....on 2 of the 3 walls!

So in I walk at 1:35 (hey, traffic was bad, and I did say "ish!"). I was going to be an extra set of hands until 3pm when I would be put into an assignement. As I walked around asking nurses (there were 22 on...we needed about oh, 30 if you asked the ones that were there!) if they were ok, they all gave me an exasperated look, like "DO I LOOK OK??"

Ummm, nope....moving right along : )

Just kidding....I helped!!

However I had to stop right in my tracks when I came across this patient: a 17 year old developmentally delayed, half deaf, mostly mute, girl with a trach (permanent breathing tube in her neck) semi-attached to her ventilator was jumping on her bed....gown thrown on floor....diaper shredded beneath her...poop dripping all over...and trying to pull out her trach! She was making sounds and doing sign language because she was NOT happy!! Her ventilator was beeping off...as were ALL her monitors because she had effectively jumped off all her cardiac/oxygen leads!!

So why was she unhappy?? For one, who wants to sit in a poopy diaper...and for 2, she has this obsession with babies!! If she hears one crying she will sign OVER and OVER and OVER "baby" and "crying".

OK, so I'm not sure if it is true sign language, but it's her language... and she's what we call a "frequent flier" so I've gotten to know it over the past 6 years! She makes a cradling of a baby motion...and then draws tears on her cheeks....good enough for me!

So while her nurse was in the room across the hallway (oh, about 6 feet away) sweating profusely in her isolation gown, gloves, and mask, trying to calm one crazy mad baby who was also flailing in bed, I took charge of miss "shredded diaper-poopy bed-with my breathing life support barely hanging by a thread on my neck" patient!

She didn't seem too concerned with the show she was giving all families and employees walking by- and let me tell you, developmentally delayed teenager does NOT mean physically/maturationally delayed!!

So once I cleaned up the crazy mess, and reassured her oh, about 500 times that yes, the baby is crying...but yes, the baby was ok...she seemed to settle down!!

The rest of the day was certainly crazy busy, and I took care of a really sick baby with a really sick heart, but hey it's just what I was expecting. Adventures such as this can be expected on "Please come in whenever you want" desperate Fridays.

It's the other adventures that always throw us PICU nurses for a loop...but it keeps us laughing!! And THAT is what keeps us going! That is what keeps us on this crazy adventure that we call PICU nursing!

Wednesday, November 17, 2010

The 35 year old in the PICU

Every once and awhile, we'll get an adult in our PICU that had heart surgery as a baby, and now our surgeons are the only ones that know how to repair what they did 30 some years ago. So these adults come back to the PICU.

Yesterday I was the lucky winner of taking care of one such adult. Only she wasn't there for another heart surgery....she was there with pneumonia.

Now what in the world is an adult with pneumonia doing in our PICU!?!? Such is the way we roll sometimes apparently! In all fairness, she does have a complicated heart history & that's what brought her to us as opposed to her local hospital.

Taking care of an adult is NOT like taking care of kids!! Stated in another way: Kids are not little adults!!

I had a few laughs yesterday because sometimes our vocabulary goes on autopilot. But that needs to be changed when an adult is in that PICU bed!

Saying "Do you have to go potty??" is not so appropriate for an adult!

Or "does your tummy hurt?"

Or "Can you show me where your owie is?" (owie DB, not ooie!)

And things like automatically cutting up their food when it arrives isn't so much appreciated!!

But just like kids, she started getting cranky and whiney in the afternoon...so I implemented mandatory naptime. I turned off all the lights, turned off tv....made a nice quiet, dark environment for her to take her nap.

Even though she's not a kid, sometimes adults need others....PICU nurse....to take charge! And so I did!

But unlike some of the kids I take care of, I refrained from telling her "You can't get back up until you put your happy face back on!"...unfortunately, I think the words "Tell me if you have to go potty so I can help you" may have come out : )

What can I say....I'm a PICU nurse through and through!!

Friday, November 12, 2010

A Little Inspiration

Clinicals are over! Most projects and readings and lectures are caught up on (mostly!) Nothing exciting at work yesterday....

Oh what to blog about....

Here's a little inspiration that I found today while catching up on some of my leisurely reading. As a PICU nurse, we don't always focus on health promotion as actively as we should....we focus on breathing promotion, or keeping your heart beating promotion...or just staying alive promotion!!

BUT- as we are discharging more and more kids from the PICU, it is imperative that we give them education on healthy eating and staying physically active as they go home. This is one great thing that Primary Care offices do so well (at least the one I had clinicals in!!).

And why should kids do this???

Number 1, it will help them to lead a much healthier, longer life.

Number 2, maybe one day they can be in a magazine like this lady (currently 86 years old):

"Running is my fountain of youth. I ran high school track in South Carolina in the 1930's but then moved to New York City and had babies. Much later on, in my 70's, I worked for an elderly lady whose daughter jogged, and that inspired me to get some running shoes. I ran my first marathon in 1998 at age 74."

Yup, you read that right!! Hello!!!

I'm not sure what I find more amazing...that she ran her first marathon at 74 (ok, really, that she ran at ALL at 74!!)

OR that she said when she was in her 70's that she worked for an "elderly lady." I love her perspective on life!!!

And it started with her being active in high school (and probably much sooner than that!!)

So there's some inspiration for ya....to get off the couch, to lace up some sneakers, and to pound the pavement (or lift the weights, or climb some stairs, you get the point!). If this woman can pick it back up at in her 70s, kids today can too. And so can I. And so can you!!

*Found in Fitness Magazine (2008)- see, I told you I was catching up on reading...you should see my stack of magazines I need to tackle- pretty much from when school started until now!!

Wednesday, November 10, 2010

"I will NEVER drink again!"

Oh the famous last words!!

Several times a year we get teenagers in the PICU for an accidental overdose...or purposeful overdose gone all wrong. This week, the alcohol was WAY overdone for one 17 year old.

Apparently he and some "friends" were having a great night out...including a ton of drinking. They decided that it would be loads of fun to take a walk, but weren't quite coordinated to do so. PICU patient had WAY too much to drink and passed out.

Yup, just passed out, right in the middle of the street when they were trying to cross.

Well, at least his friends were "friend" enough to drag him to the sidewalk. But that's pretty much where their friendship ended! They saw an older man walking by and stopped him saying:
"This is our friend 'PICU PATIENT'- he just passed out"...

AND THEN THEY RAN AWAY!!!!

Luckily, this older man was not some psycho...or murderer...or rapist. He called 911 and the kid was brought to us.

However, the kid was brought to the ER, only knowing a first name and that he "passed out." After a ton of tests were run to figure out the cause of his passing out, it was ruled he was severly intoxicated!! So, he bought himself a stay in the PICU to sober up.

We had him connected to monitors and gave him loads of IV fluid. As he started waking up, we were then able to ask questions. Like, what is your last name? Do you have family that we can call??

His mom came in several hours into the day. Apparently she wasn't too worried that he didn't come home that night. Apparently this behavior is not too out of the norm for him. She certainly didn't have any sympathy for him.

The more he woke up, the worse he felt. At one point he started getting agitated saying "My head is killing me. Something is wrong!" His mom said, "Shut up- you just have a nasty hangover!"

Now ordinarily, horrible acute headaches would warrent concern for us PICU nurses....but we'll agree with mom on this one!

Numerous times throughout the day after vomiting and struggling through pounding headaches, the patient swore up and down that he wouldn't drink. Ever again! I believe "I will only drink water for the rest of my life" even came out of his mouth!

For this patient, that's probably a good idea. Scratch that, great idea. With the way he drinks, the amount he drinks, he can't afford to keep up this behavior!! At roughly $3,000-5,000, that was probably the most expensive night of sobering up this patient has ever seen.

Sometimes it's not always about the adventures that we go through as PICU nurses. Sometimes its about the adventures that our patients go through.

I think it's safe to say, this was one adventure this patient did not bargain for. One adventure that he will hopefully remember for the rest of his life. And next time he goes to pick up a bottle, a flask, a jug (whatever teens are drinking out of these days!), he will remember his famous words: "I will only drink water for the rest of my life!"

And if he doesn't stick to it, his next adventure should include finding some new friends. One that won't leave him passed out on the sidewalk!!

Saturday, November 6, 2010

When a PICU Nurse gets sick...

When a PICU nurse gets sick, it isn't pretty.

Taking a "lunch break" to walk to CVS for pepto is NOT so much a "break"

Clearly not a break when the pepto comes right back up...throwing up in the locker room- definitely not pretty.

But where the true nurse shines through is in the attempt to go back and care for her 2 patients after the throwing up episode (yes, we know...nurses are the worst patients ever!)

It gets really ugly when PICU nurse almost throws up in one patient's room after smelling the patient's formula (thank goodness no parents were there!)

Then as she is running down the hallway, she almost throws up there...but makes it to another wonderful PICU bathroom toilet. Oh the joys of hugging a hospital toilet!

After barf number 2 she gets wise..."hmmm, maybe I should be going home!"

After throwing up episode 3, she realized, "hmmm, I don't think I can drive home"

So wonderful husband picks her up.... not before she has throw up #4 right outside the hospital doors... on the sidewalk... with employees and families walking around... and staring!

Not the finest moment for this PICU nurse!! And the fun begins again tomorrow....

Thursday, November 4, 2010

My Last Day of Clinicals....in numbers!!

I had my LAST day of Primary Care Clinicals today!!! So happy....So sad!!! (well, mostly happy to be done!)

I still have 3 1/2 weeks of class left in the quarter, but it'll be nice to have my thursdays back to get homework done, so our weekends aren't so filled with tv/homework dates : )

So on my last day of clinicals, what did I see??? Here's my day in numbers:

5: Number of days a 15 year old has had a headache after bumping her head on the car door corner....

0: number of tylenol or ibuprofin (or ANY pain reliever) doses she's taken to get rid of the headache

1: number of concussions she thinks she has

0: number of concussions she REALLY has : )

4: number of patients seen for ear infections

3: number of ear infection patients who had a complaint of "my ear hurts really bad"

1: number of ear infection patients who did not complain of pain, but "my ear is booming" instead! (4 year old)

2: number of ears yellow fluid and some pus was draining out of profusely....EWW!!!!

3: number of patients seen with epistaxis (sounds scary- it's not...it's a nosebleed!)

0: number of epistaxis patients that had something "wrong" with them....it's dry season people!!

1: number of really cute patients seen dressed in all pink (including socks and crocs), who when I told them Pink was MY favorite color too, she replied, "Oh I don't really like pink, my favorite color is Gold!"

1: Number of patients that PROJECTILE POOPED profusely ALL over my preceptor as she squeezed his butt cheeks together after administering rectal tylenol

3: Number of people in the room when it happened

1: Number of people laughing hysterically!! (Me)

2: Number of people screaming (the 15 month old patient and my preceptor!)

Too many to Count: number of memories, laughs and lessons learned today, and every other day of clinicals at this amazing pediatrician's office

Thank you SO MUCH xxxx Pediatrics....you have taught me so much and my time spent with you was invaluable!!

Monday, November 1, 2010

PICU Nurse asking for Prayers

Jon and I have some friends who got some bad news today about the daughter they are expecting in 20 weeks. The ultrasound showed a potential neurological defect and the doctor is concerned about a few other findings.

Our friend called, devastated, at the news he just found out today. What was supposed to be an incredibly joyous occasion, ended with the doctor saying "Either way, your daughter is going to be disabled." While we are super excited about the news of a GIRL (!!!!), we also are so sad for them!

What I know: I believe in a God that can do miracles...only He can change the outcome of this little one, currently forming in her mother's womb. No doctor can prescribe this. No ultrasound technician can make it mysteriously appear on the screen.

What I Wish I Knew: I wish I knew the answers for them. I wish I knew that she would be ok. But, I don't. I am PICU nurse. I am JUST a PICU nurse. I cannot see the future. I cannot make miracles happen.

If I could, I would for these friends. I would form this little one's body so perfectly....I would mold her hands and feet, and allow them to move, showing her mama and daddy how precious she really is.

But all I can do, all PICU nurses can truly do, for their patients...and their friends... is pray for them....give them support... and be there for them throughout some of the toughest times in their life.

So please join with me in praying for this little one....for all the little ones out there...who's parents are grieving at the diagnosis, the prognosis of their precious baby!!

We love you!!!

Thursday, October 28, 2010

Loving Primary Care

"Doo-doo-doo-doo, Doo-doo-doo-doo" (hopefully you're hearing the scary music in your head and not picture tons of poop....though that would not be too far off for this blog!!)

It must be Halloween time....freaky things are happening!!!!

I, passionate PICU nurse, lover of all things acute, fast-paced, adrenaline rushed etc. am LOVING primary care clinicals!!!!

I know, I know, my advisor would kill me!!! BUT- as I'm learning more and more, and getting better and better and diagnosing and treating independently, I love interacting with healthy kids for check-ups and sick kids that don't require breathing tubes and tons of IV drips just to stay alive!!

That being said, primary care does have some downsides. Case in point: the 9 year old that I saw today for "sore throat". He let me look into the his throat with my light, but ABSOLUTELY would NOT let me swab him for a rapid strep (which I pretty much could diagnose without the swab b/c he had a very erythmetous (red) throat with pustules, and petechaie on the roof of his mouth!). I literally had to hold him down on the table and have parents hold his head and limbs!!

Except parents are never good "holders" because they can't stand the sight of their poor little one being strapped to a table and screaming bloody murder.

Enter the 6' giant of a preceptor that I have (woman....VERY tall woman!!!) I told her I needed help....and it literally took her LAYING on top of him, prying his mouth open with 2 tongue depressors, mom holding his head, and me swabbing!! Seriously??? The kid is probably traumatized for life now....It's just a cotton tip!!!!

But then there was the 18 month check-up who's 4 year old brother was accompanying him. Every question I asked the dad (ie: how is he eating? how is he sleeping? pooping and peeing ok? etc.) the brother would answer!! He said things like, "Oh he is a wonderful baby!" and "hee hee hee... he poops every day...a lot...and it stinks!"

And then, when I had the dad sign consent for the 3 immunizations, the brother said "Oh that's NO good...he's not gonna like that!!!" But later he said, "Well, I'll sing him songs when he gets the shots and then I'll give him an icepack."

Super sweet!!

So there ya have it folks!!! After a day of sumo wrestling one 9 year old, having a great conversation with a 4 year old, and many exciting things in between, this PICU nurse loves the adventure that is also known as Primary Care!!

Wednesday, October 27, 2010

What they teach in grad school these days!

So I'm trying to get caught up on my weekly Primary Care readings....

(ok, caught up on last weeks readings!! You gotta start somewhere right???)

Anyways, we're learning about preschoolers this week....normal development, anticipatory guidance, common illnesses, etc. etc. etc.

So in the 16 chapters of advanced practice nursing stuff that I'm expected to read is the following (brace yourself, you might not feel capable of keeping up!) :

"Nose picking, noted in children and adults, is reported in more than 90% of individuals. In general, adults and older children limit nose picking to when they are unobserved, but younger children will pick their noses in public. There are no gender-based differences in the incidence of nose-picking. Epistaxis* is the most common complication of nose picking."
*image via google

Really?? REALLY??? I can't believe this reading is mandatory!! Oh I'll be really prepared to take care of sick ICU kiddos on life support with this added knowledge!!

At least it provided some comic relief...I mean, I really paused after reading that and laughed!! Whoever said being a PICU nurse is all sadness and seriousness has never seen Advanced Practice PICU nurses grad school readings!!


*Epistaxis- nose bleed

Reference: Berkowitz, C. (2008). Pediatrics: A Primary Care Approach. Los Angeles: Saunders Company.

Sunday, October 24, 2010

A Nurse Through and Through!

This weekend, a bunch of friends got together at our house to have a Fall/Halloween weekend of fun. We ate a bunch of food, watched 2 scary movies (Children of the Corn-2009 version...NOT so scary, and Exorcism of Emily Rose...SO scary!) and then ventured off to the haunted corn maze.

While I LOVE planning days like this, I was not the coordinator...gee I wonder why, with my schedule lately!?

So, an e-mail was sent out to all of us getting us ready for the Haunted Corn Maze. On the "What to Bring List" was "glowstick" for light to see the map in the maze. Now in MY opinion, what I brought WAS a glowstick!!

Apparently, it wasn't what everyone else was thinking of : )


It's probably way to small to distinguish in the picture, but my glowstick was a pen light....courtesy of the PICU. Hey, it's a stick, and when you push the button it glows, so I think it counts : )

Guess I'm just a nurse, through and through!!

PS: For those of you that subscribe and get e-mail version of my blog, I'm not sure why you were sent a really old post recently. Jon does NOT have a new job....he did back in May when I posted it. Hopefully you'll just be getting posts as I write them!! Thanks for those of you that noticed!

Wednesday, October 20, 2010

Nonconventional Medicine

I got an e-mail from my Great Aunt today reminding me of some of the popular medicinal remedies used for children (and adults) in the past... interesting!!

Heroine was sold in the late 1800's as a "non-addictive" (HA!) substitute for morphine AND was most commonly used for children suffering from a "strong cough"



Maltine with Coca Wine was bottled and recommended for "making you happy"- on the label: "Recommended to drink one glass after every meal. Children should drink half a glass."



40% alcohol + 3 g opium in each tablet? Treatment for asthma?? Probably NOT...but perhaps the patient felt so "good" they didn't even care they were still wheezing!!

Cocaine Toothache drops... very popular with the kids in 1885 (gee, I wonder why!?)



And for those newborns that were feeling left out out being drugged up...for medicinal purposes of course : ) ... how about some Opium as a sleep aid!


Wow, have times changed!?! If this nurse used any of these old school treatments, that would be a WHOLE different kind of adventure!!!

Monday, October 11, 2010

When PICU Nurses get bored!

I worked this weekend. Weekends (when well staffed) are notorious for being nice and quiet (dare I actually say that out loud!?) Less docs to bother you, less family to ask crazy questions and make weird demands....just less action going on.

And then there are the weekends where there is SO much less "action" that it just becomes painful!!!

Now lately, I have welcomed these days b/c I can rock out some major homework and get caught up!! But, yesterday was just not one of those days!! I was NOT feeling the homework!! I kept pulling up my paper that I was working on, blankly staring at it, and then closing it down...who wants to think about a 3 month old with reflux and what i'll order and why...all while working! Ugh!

There are just those days when I've had ENOUGH with the homework!! Too many papers, too many tests, blah- blah- blah!!

So, while my kiddos were napping (most of the day actually....I told you it was a quiet day!!) I was researching for our upcoming cruise (hey, a PICU nurse/grad student has to stay sane...and it was an incredible cheap deal we couldn't pass up on!!!)

But then about 5:45 pm came around, and all that quiet came crashing down. We were getting 7 admissions....and did not have that many nurses to take them all!! But, since EVERYONE was SO bored (17 nurses on, one charge nurse all sitting around, all day....yes the definition of "sitting around" in the PICU as a nurse is very different, but sitting around none the less!) we all were ready to get into the action.

Here's the problem. If I leave my bedspace, I have to find another nurse nearby that can watch my kids/their monitors. Near me were 2 other nurses....all who wanted in on the action also!! We had 2 kids coming up from the ED stat....one 5 month old trauma/full arrest, and a toddler in full septic shock (= really bad bloodstream infection, intubated, really low blood pressures, SICK!).

To decide who got to go admit the kid, there was a little "rock paper scissors/what I've done today game." I lost right away b/c someone called me out and said "You got to give your kid blow-by today...you've actually done something." The other girl had an hour of action when her teenager was potentially gonna get intubated (but didn't). So that left our 3rd nurse, who had a pretty sick kid all day, but was super stable, so not really requiring nursing interventions! So she won out....she got to get in all the action.

It's amazing how we nurses thrive on the fast pace, the action, the adventure that goes on in the PICU. When it's not there, when it's a quiet day, you can just tell.... every nurse is no longer in his/her element. But don't worry....it's the PICU....the adventure always seems to find it's way back!! And that's why I LOVE it!!

Wednesday, October 6, 2010

Interesting Case

Warning: This post is educational....you will learn a little bit (or a lot!)- with all the case studies I have to write for school, this is actually a real life case from the PICU. I found it interesting, hope you do too!

So the little man I've been taking care of since early summer definitely keeps us PICU nurses and docs on our toes! I worked last Friday with him and we had a typical, fun day....no big events, nothing out of the ordinary.

But then the weekend came....I wasn't there (several of the docs and some nurses said this was why he was "acting up!" apparently I have to be at work 24/7! HA!) Three times over the course of the weekend he had a decrease in his heart rate, his pupils became pinpoint, became unresponsive, and had tons of secretions (the secretions thing is nothing really new though). He got a dose of atropine each time this happened, and it woke him right up...and perked his heart rate right back up to normal.

Of course each of the episodes happened on the night shift, when there is a skeleton crew and less people that "know him" around. So Monday and Tues this week were spent with many consults from the neurologists and autonomic specialists to figure out exactly what's going on.

This little guy, as I've said before, is almost three years old and has what's called Cervical Spinal Stenosis. I know, I know, what is CSS?? Easy definition: the spine in his neck is much more narrow than it should be, causing pressure on nerves that innervate the organs and his arms/legs, not allowing him to move or breath normally (this is why he had to get a trach over the summer). He has had to wear a full upper body brace his entire life, and still has about a year to go until he can get a surgery to hopefully repair the narrowing (stenosis).


So what are these events that keep happening?? Well, along your spinal column you have your Sympathetic Nervous System ("Fight or Flight"- keeps the heart rate up, dilates the eyes, dries up secretions, slows down the gut, etc.) and your Parasympathetic Nervous System ("Rest& Digest"- heart rate decreases, pupils constrict, gut motility increases to digest food, secretions increase, etc.).

Normally the SNS and PNS keep each other in equilibrium so that one doesn't dominate the other. Our bodies typically do a great job of "increasing" one while "decreasing" the other when it's necessary....(for example- the stories you hear of mother's lifting cars off their children r/t adrenaline is possible b/c the SNS kicks in!)

HOWEVER, when you have a little one that has narrowing in his cervical spine, this can compress certain nerves within the SNS or PNS. SO- over the weekend, his PNS "kicked in" more (perhaps his SNS is slightly more compressed recently??) which caused the decrease in HR, pupil constriction, and unresponsiveness.

Now that we know WHY these events are happening, the docs and myself are researching how to best prevent it from happening again. There is not much literature out there on this topic, but it's exciting to be a part of a team trying to improve the quality of this little one's life. Oh, the exciting adventure I get to be a part of as a PICU Nurse! Love it!!

Here's a little "Fight of Flight" humor...just to prove I'm not making this stuff up : )

Sunday, October 3, 2010

SO done with school....and a fun weekend!!

It's a good thing Jon and I had a great weekend, b/c otherwise my post would only be ranting about school!

First the rant: I am officially getting SICK of school!! Correction: I am officially sick of school. It's been over 2 years, and while I started saying "I LOVE school" my song has definitely changed!! I am so done with being stressed out because of it....and I'm so done with papers, putting up with teachers, and not having much time for anything other than school and work...and the VERY occasional fun thing.

It's mostly the teacher thing that is frustrating me (eg: don't give me feedback that my paper has been written very well and much improved from the last one...but then give me a B- w/o reasons why!) But enough of the frustration...

Onto the fun!!

This weekend Jon and I went to a Fork, Cork & Style Festival. We had BLAST watching Top Chef contestants and Emeril cooking at live demonstrations, eating their food, sampling 13 other restaurants, and having a wine tasting!! We were able to try over 200 kinds of wine (ok, well, we didn't try all 200, but there were options!!) We had 6 glasses that were over $150 bottles....hello!! And surprisingly, NOT that good!!
But, what does this have to do with being a PICU nurse!? Well, not much really, other than the fact that there is VERY little time for fun these days, and I felt the need to post about it! But, one quality required of a PICU nurse is to be adaptive and creative. THIS I was....


You can't see it, but I had one nasty blister that was bleeding into my shoe....( and another 2 on my toes!)

So I improvised and came up with the best solution for this clear acute injury : )


Wet wipes!!! While this nurse did not have any band-aids left in her purse, I did have an alcohol swab to clean the area with (OUCH!) and then the wet wipe to act as a barrier between my broken down skin and my shoe!


Now that's one creative PICU nurse!! : ) Hope you all had a great weekend!

Thursday, September 30, 2010

Thursday's Tip

It is an interesting phenomenon to see the two different kinds of parents that exist out there: The one calls their pediatrician...scratch that...goes straight to the ER for the slightest little cough. The other has a crazy sick kid at home and doesn't take them into their pediatricians office until they are blue...in which case they needed to stay at home at call 9.1.1!

So here's my best Thursday PICU nursing advice if you fall into the latter category: if your child has asthma and you are giving albuterol nebs every 3-4 hours a day....call your pediatrician.

If your child has asthma and you are giving albuterol nebs every 3-4 hours for FOUR days.....PLEASE GO to your pediatrician.

However, know that once you get there, your poor little man may need way more albuterol than they can safely give in the office.

SO, he will be admitted to the PICU....most likely b/c he needs continuous albuterol!!

This is the interesting cycle I was able to witness having clinicals in the pediatricians office, and then working in the PICU. While the kid didn't get sent to my PICU, he was sent to the local one nonetheless.

Despite education and re-education from the pediatrician, this mom has brought her 3 year old in too late several times in the past 2 years...requiring 6 hospital admissions!!

While it was a great office clinical experience....and while I love taking care of cute little asthmatic kiddos (see previous post for another asthma cutie!) this is NOT the path kids should have to go down.

So for parents in category 1: Your childs cough (that he did ONCE, without ANY other symptoms) does not mean that he has swine flu or a horrible pneumonia or is dying of some terrible disease that warrants a trip to the ER....he probably swallowed the wrong way, or licked something dusty off the floor, or did one of the other insanely gross things that toddlers do that you would die (but not them!) if you knew about! : )

And for parents in category 2: for the love, yes, when your child has a cough that is not stopping...and you know they have asthma....and you are giving tons of albuterol....YUP, take them in to see the office Nurse Practitioner....otherwise you'll be having an unwanted adventure with the nurse in the PICU!!!

Wednesday, September 29, 2010

"I'm so boring" ....

My lack of blogging is reflective of my lack of anything outside of school and work right now!! My friends feel like I've abandoned them (though they totally understand!) and my husband re-introduces himself to me several times a week ("hello, I'm your husband, so nice to see you!) Ha!!

This week I have a break from clincials b/c I did double time last week. I thought I'd party on my 2 days off this week, but realized, nope, not with 2 papers due Monday and a test Wed! Hello! So it's paper writing time!

BUT First, 2 funny stories from work:

1.) I had a 3 year old asthmatic who had to be on continuous albuterol. Now, if you've every taken a puff of albuterol from an inhaler, you may remember feeling a bit jittery, or like your heart is speeding. So imagine a 3 year old getting this CONTINUOUSLY!!! Poor guy's heart rate was WAY up and he wanted to "run around like a race car" all day. And of course, I kept having to tell him no. By the afternoon, he kept saying "I'm boring...I'm so boring" ... to which I kept having to remind him, the word is "bored" not "boring" : ) So cute!

2.) I was trying to get some homework done at work yesterday when it was naptime for both of my patients. I was in an area of the unit that we like to call "The Alley" because there are no doors to the rooms....just 7 rooms on each side of the hallway facing each other. Great place to be when you need help b/c there are nurses so close by. BUT- not so great when the website you pull up is SO not appropriate for work....and a 4 year old is walking by with his parents and grandparents!! Hello!! I am writing a paper on breastfeeding and had to do some research....what I thought would just be an "educational" site (it was a required reading for this assignment!) was the picture book style education. Right as the kid was walking by, Hello nipples!!!... ALL over the screen!!! I scroll down to get to the "word" section of the article, but nope....more boobs!! Finally I realized, just X out!!! But not before I was thoroughly embarrassed....who knows what this family thinks I was trying to look at!!! Ahh! : ) Just gotta laugh!

Sunday, September 19, 2010

Using my Brain

I walked into the PICU last Thursday having NO idea what kind of patient(s) I would be taking care of. After 4 months of taking care of my chronic kids, it was all up in the air!!! So I walk into taking care of the sickest kid on the unit. Correction: sickest MAN on the unit! I had a 37 year old male who had a huge heart surgery the day prior and was sick....really sick!! I was super busy all day....I didn't sit down the entire shift! He had blood pressure issues, arrythmias, and sedation problems. I had to contact numerous docs to get the answers that I wanted. It was tiring. It was mentally exhausting. And it was AMAZING!!!

I left work remembering why I truly love the PICU!! Being able to use my brain, to critically think, to act quickly in response to the slightest little change....it's so exciting!! People walked by throughout the day and said, "Wow, they really didn't ease you back in, huh! They just threw ya back in there!" Oh yeah, they did. And, oh yeah, I loved it!!

And then the next day came my first day of clinicals. Clinicals in a primary care office setting. Could not be any more opposite of my exciting, amazing, PICU setting.

And yet, it was WONDERUL! I truly cannot say enough great things about it!

I mean, I really surprised myself with how much I learned and how much I LOVED it!!! The idea that office work is boring is just plain wrong! In fact, it was just as busy as many days in the PICU....without the stress of having to keep patients alive! SO nice...go figure!

My "preceptor" is a Pediatrician, and although medical students receive very different training than Nurse Practitioner students, this doc is one amazing teacher!! She had me come in and observe the first two patients of the day...and then threw me out on my own! Hello!! She figured that since I have had PICU training/experience, that this should be a cake walk for me. She was more excited that if someone came through those doors super sick, she'd have someone with her knowing exactly what to do!

It was honestly so great! I would go in and see the patient, take a history and do a physical....then I would go present the patient to the MD who would then go do a follow-up exam...and we would send them off together. I am learning SO much about basic, healthy kids (ie: immunization schedules, basic developmental milestones, skin disorders/rashes etc) and it's awesome!! Those are things that are clearly not of importance when a kid is on life support in the PICU....so it gets pushed to the back burner.

And what's great is with my PICU experience, I'm able to give parents so much information on disorders and diseases from an inpatient perspective that the pediatrician is not able to give.

SO- on my first day here's what I got: a TON of well patient check ups ranging from 2 weeks (SO cute!), a few 6 and 9 months, a few 12 months, and a few back to school check-ups. Then, we got an asthmatic that we admitted to the hospital, a football player with a broken finger, a cross country runner with shin splints, and a 16 year old who was self diagnosed as pregnant....and sure enough was (that test came back positive in less than a second...no 3-5 minutes of waiting necessary!)

I think the biggest reason that I love this setting is the amount of patient and family education that is involved...and I'm realizing more and more what a passion I have for teaching. I always know that eventually I would want to teach at the college level, but this shows me more that whatever job I take once I graduate, a big component needs to be revolved around teaching!

On the job front, I haven't been back since my last post, but I have had several people call and text me: the boy I just sent up came right back down : ( Apparently he got a mucous plug in his trach which occluded his airway...which caused him to "brady"(heart rate go down too low), which caused him to get compressions, which bought him a one way ticket to the PICU. So, I know where I'll be on Tuesday at work!

So while I may not be "using my brain" as much as last Thursday when I go back to work this week, I know I'll be giving some great PICU care to a boy who probably needs a familiar face right now....and that makes this PICU nurse ready for the adventure ahead....as chill as that may be : )

Wednesday, September 15, 2010

Long time...Long Post!

Wow- it has definitely been awhile since my last post. Part of that was because we went on vacation, and then I had 2 weeks off of school (SO needed!)

But I've been back at it now and work has been CRAZY!!! One day last week the code button went off 5 times before 10:30am. One little baby was getting a bath and her heart just stopped (she is in the hospital because she just had heart surgery)- so she was crashed onto ECMO (think heart and lung bypass machine similar to what is used in surgeries). A second kid decided to stop breathing and had to be intubated. The third kid was a liver transplant who started having arrythmias (funky heart rhythms), lost her pulses, and needed compressions. The other 2 were farther from me so I didn't get involved. But, let me tell ya, one true code is enough for a day....5 is out of control!!

We have had 3 kids die in the past 2 weeks which has been hard (2 had cancer, one was waiting for a liver transplant). Like I said, crazy at work.

On a more positive note, I sent my other boy up yesterday to the general floor which was bittersweet...probably more bitter than sweet! It's great to see him getting better, but so sad to see him go : ( 4 months is a long time to take care of a little kiddo. So I've made my way out of my corner and will (hopefully) find another nice little assignment with a great family to take care of. I told the nurse in charge yesterday if I come in Thursday and am put in 218/219 I will not be laughing! I need a break from that corner...especially now that my boys aren't there!

One day last week I took care of the cutest little 15 month old boy- blonde curly hair and wildly blue eyes!! He had croup and was working pretty hard to breath (ok, really hard, we thought we were going to intubate him for awhile, but he got better!) and so he couldn't eat. BUT- the next day I was there he looked tons better and all he kept asking for was "ham"- He said it in the cutest little high pitched voice. So he got his ham....ate a bunch of it, and then promptly threw up all over his moms lap! No later than the second he closed his mouth after barfing up his whole dinner, did he say "ham!" hello, kids crack me up! I'm pretty sure when I throw up, the last thing I want to do immediately is eat....especially the same food I just threw up! YUCK!!

On school: Clinicals start this week- I'll be going once a week to a primary care office, so I'm looking forward to it. I'm sure it will be lovely being in an office setting during cold and flu season....oh boy!! Classes don't look too hard....Peds Pharmacy is writing intensive so I'll have to write a 4-6 page paper each week but that's not so bad....and then Pediatric Primary Care has 3 projects and 3 tests, so again, not so bad. My 3rd class goes along with the clinicals and will just involve short write ups, so piece of cake! This will be the busiest class schedule for me until I graduate, so I just have to get through the next 10 weeks. I can do anything for 10 weeks (my mantra over the past 2 years!!)

I'll post an update this weekend to let you know how my first day of clinicals went!! Exciting!!

Thursday, August 26, 2010

2 Days, 2 Good-byes

Over the past 2 days, I have had to say good-bye to 2 things.

Yesterday I said good-bye to my "PICU boyfriend"...something us PICU nurses always joke about with our kiddos that we've taken care of forever. Ask any PICU nurse and they'll rattle off several "boyfriends" or "girlfriends" they've had over the years. One of the many joys of working in a setting that allows us to take care of the same patient over an extended period of time.

My older of the two boys I've been taking care of went up to the regular floor yesterday. Great victory for him as it is one step closer to home...but sad to see him go : ( 5 months is a LONG time to take care of someone...

Hopefully he'll stay up there for a short time, and then make it home. Unfortunately there's already a bet among our unit as to when he'll be back. That's one bet I'm NOT entering!! (But, on a side note, I did tell the charge nurse yesterday to keep his room open for the next 5 days or so...just in case! Wouldn't want my 2 boys to be separated if they did happen to both be in the PICU again at the same time!)

And my second good-bye: PEACE OUT PHYSICAL EXAM!!! Well, P.E. class anyways!! I suppose my entire job is based largely around physical exam so I'm not kissing the concept good-bye....just the tests, the readings, the classwork etc.

I took my final today and was SO glad to be done. Interestingly, it was the easiest test of the 3 that we had....or so I thought....I did the worse on this one compared to the other 2. Oh well...apparently STI's (sexually transmitted infections), male/female genitalia, and musculoskeletal issues are not my thing. Not sad there!!

BUT- regardless of the exam, I rocked out another 2 A's this quarter. And a special thanks to my sister (HAPPY BIRTHDAY TOO!!!!) who helped me get an A on the last physical exam video!! You made a great "18 year old college student with a wheeze and cough"- so believable!!

So 2 good-byes in 2 days.

Now, I'm getting ready to say hello to a full Fall semester...and probably a full room 219 in the PICU....and looking forward to seeing what adventures these "hellos" will bring.

Wednesday, August 11, 2010

And Another Health Fair

I can see the light at the end of the tunnel. I finished my last health fair of the summer, and tomorrow is my last day of work before VACATION!!!!

I. CAN'T. WAIT!!!

The health fair today was very different than the past 2. Rather than a majority of Spanish speaking families, this one was at the Polish American community building. And, the kids came by themselves. So, it made for collecting the history section of their back to school physical form near impossible...but quite enjoyable!!

Case in point: I asked one 9 year old if he was allergic to bees. His answer: Oh Yes!! So I asked, "What happens when you get stung by a bee?" His reply?... "I get swollen huge and die!"

I tried so hard to not laugh!! I wanted to say, "so this has happened to you before!?" but instead I asked if he'd ever been stung by a bee...to which he replied no. So then it was all about trying to figure out how or why he thought he was allergic to bees. Long story short (kinda!) he heard this information from someone at school. So scratch out my check mark on the YES box for "allergic to bees."

Another little girl I was examining asked if I was Polish. I said No. She said, Wow, you really should be. The way she said it was like "Maybe next Halloween you can become a Polish girl-it's the way to be...everyone around here is Polish!" Funny!

And lastly: I asked one 6 year old if she had asthma. She said "Uh-huh" ...paused for a few seconds...and then said, "Wait, what's that!?"

Yeah....trying to ask kids if they have hypertension, polycystic ovarian syndrome, a family history of diabetes mellitus or asthma can give you some really creative answers!! But it will definitely NOT give you answers to properly fill out the health history questionaire.

While these back to school health fairs have been a lot of fun, they have taught me that the adventure of a PNP (Pediatric Nurse Practitioner...works in an office/clinic setting) is probably, scratch that... definitely not the type of adventure that I'm drawn to.

I'm in the acute care peds. nurse practitoner program (ACPNP-can work in a clinic, but usually specialized, and can also work in the hospital setting) for a reason...there is an adventure in the PICU that just cannot compare. So I will continue my journey in the fall seeing kids with sore throat, earaches, and runny noses at the offices...but I look forward to the adventure that follows the 3 quarters after!!

Friday, August 6, 2010

Halfway there!

So I am sitting in my car outside of school SO grateful that it's Friday! My first week of putting in 70+ hours (not including any homework) is almost done! And just one more week of this craziness until I'm chillin' in the sun at the beach in NC!

SKIP TO SATURDAY: Ha- such is my schedule that I only had time to write 3 sentences before moving on!! Work and school this week were CRAZY...work b/c I have taken on WAY too much "extra" stuff (go figure!!) and school b/c they decided it would be a good idea to cram all 3 health fairs AND school days into 2 weeks this summer...apparently they assume we don't have jobs...or lives!!

So Wed. was a 12 hr health fair that I have to say went WAY better than I thought!! Reason for apprehension??? Testicular exams for back to school physicals...on teenagers!! Awkward!! Jon's request was that I wear no makeup, pull my hair into a messy ponytail and "not dress cute at all."

In all honesty, it was only as awkward for the boys as the nurse practitioner (me!) made it, so it went fine!! Only once did a mom laugh as the poor kid was pulling down his zipper (don't worry, we take him to the corner of the room and face the wall, so nothing is exposed). But, hello, what mom LAUGHS at that???...the poor kid got SO embarrassed!!

The one funny part about is though was we were given a "necklace" of balls...literally...to help us "stage" each of the kids (translation: feel the kids testicle, then find the bead/ball on the necklace to determine size...then look at a chart to make sure the testicle is not way too big or way to small for their age/maturity). And wouldn't you know, the ball necklace is blue!! Go figure!!
: ) Who comes up with these things...nice medical technology!

Other than that, it was looking into a TON of VERY waxy ears...and goobery noses! not too shabby! The cool thing was being able to work with normal, healthy kids...as opposed to super sick ones in the PICU.

And then the last 2 days I had my physical exam skills days...so a bunch of listening to lectures on examining a particular body system, then going to practice the exam on a peer. Then we'd get a scenario of a patient coming into your office (ie: Hi, I am a 10 year old boy and I have had a sore throat and runny nose for 10 days)... I have to take the appropriate health history and then perform the exam for a grade.

It was actually pretty cool b/c my partner (the pretend patient) had a sheet of answers, but she could only give me the information to things I asked for. So if I forgot to ask about earaches and there was a bunch of information on the sheet stating he also had bilateral ear pain, I could easily miss something, or misdiagnose!! It was a great practice to make sure we're really asking all the history questions that would go with scenarios because a lot of times, patients forget to tell you the whole picture!

I had a great small group to work with...and my Preceptor was awesome, so the 2 days went really well!

Tomorrow starts another exciting 50 hr work/school week (excluding my lovely 12 hours of driving...and bazillion hours of homework!!) Wish me luck b/c I am finishing a poster presentation for a work contest...if I win, I get $1000 (or however much out of that my unit decides to give me, b/c some does go back to them!)

This week will just be go, go, go...but such is the Adventure of this PICU nurse!!

Saturday, July 24, 2010

I got what I asked for!

It's amazing how many ways the saying "I got what I asked for!" can be said!! And I'm pretty sure I said it in several ways after my shift in the PICU yesterday!!

About 3 weeks ago my other little guy that I had been caring for (see previous posts, ie: Walking Around) came back to the PICU. He's what we call a "frequent flier!" So, I have been asking since he was admitted to have him move rooms, so the two could be reuinted again (thinking solely of their well beings of course!... OK- maybe not solely THEIR well being, but mine...really, if I was going to be paired in my far off corner of the PICU, I wanted my two boys to take care of!) Since they both just got trachs in the past 3 weeks, and their progress is slow, they will both be around the PICU for awhile. I figure they need a great nurse who will be there consistently and do all the trach teaching, so that's where I come in- see, THEIR well being is taken care of and so is mine!

So, finally after 3 weeks of asking, I got what I asked for! Little man moved back to his old bedspace....and big man got his "roommate on the other side of the wall" back.

What I wasn't bargaining for was little man deciding not to breath, desating to 26%(for those non-medical people, 100% is the number to aim for...therefore 26 is bad...REALLY bad....not liveable bad!), getting rigid chest so I couldn't bag him up, and me pushing the code button...on my first day of their reuniting! Thankfully, he passed out (again, 26% is not liveable...or awakeable!), his chest wall relaxed, and I was able to bag him back up and into reality.

Welcome back to your good ole' bedspace little man! He's done that to me before, so I guess he just wanted to relive old memories! Let's just hope those memories aren't meant to be relived over and over! Isn't there a saying "Too much of a good thing..."

So while in the morning when I found out the 2 were reunited under my care I said, "Yeah, I finally got what I asked for!!" my tune walking out of the building that night was more like, "Ha, yup, another day in the PICU...I guess I got what I asked for!" : )

Sunday, July 18, 2010

It's a Sad State of Affairs When....

*You work an exhausting 13 hours shift and can barely get your head on the pillow, only to dream about work. ALL. NIGHT. LONG.

*those dreams seem SO real you cannot fathom that the alarm clock buzzing at you is REALLY your wake up call….to go back to work! Hello, haven’t you been there a good 20 some hours now!?!?

*When something so awesome happens in said work dream, that you dream of blogging about it!

*When the actual job is not quite as good as the job in dreams

OK, so the last one wasn’t exactly true, but ALL the others were! Dreaming about work...and then dreaming about blogging about it!? Come on!!!

So what made the last statement not exactly true!? Well, part of it is I can't exactly remember the details of the dream anymore, other than I was in my typical corner at work...and working all night long. But, the other part goes like this:

I was down the hall from my patient today (same guy from all the recent posts) when I hear his “shaker” rattling. Since he can’t talk, we put a coins and caps into a plastic container with a lid which makes a good, loud noise when shaken…hence, what we call his “shaker” : )

I come running down the hall thinking he’s popped off his vent but instead he points to his fingers and does a wiping motion. I ask if he needs his hands washed and he smiles and shakes his head.

Now, in my defense the room was dark.

However, not in my defense…the odor could be smelled 10 doors down the hallway!!

I walk in to what can only be described as a murder scene….murder by POO that is!! There was poo EVERYWHERE!!! (I vaguely remember setting this scene before..and while it may have been in a previous post b/c certainly it's not the first time it's happened, it may also have been another one of my dreaming about blogging while dreaming about work times!).

Apparently he was playing his Xbox and accidentally dropped the remote control in his lap. He then realized he had poop on his fingers, so he reached for the call light/tv remote control to turn down the volume so I could hear his shaker (of course!). Once the tv was quiet, he reached for his shaker and shook...a lot...

So now he is laying in a pile of liquid brown stuff….and has (in typical toddler fashion!) smeared it on his bedside table, remote control, Xbox controller, shaker, and varying body parts! And the vigorous shaking has caused little poo droplets to fly around to the floor and one of the (close, but still!) walls. But, I remind you, he is NOT a toddler….he is 15!

*THANK goodness he decided that this was NOT the opportunity to scratch his head b/c those EVDs are just asking to become infected!

Through the entire wipe down process and bed change (which yes, dad, I did by myself!) he was laughing at me! Nice! And then for about 2 hours after it was all said and done, whenever any doc or nurse walked into the room, he wanted me to tell them the story. I say GROSS...he just laughs! Such a teenage boy!!

At least he was making me laugh today…last week he wasn’t doing so hot and we rushed to Stat CT twice…in one day! So I’ll take this teenager, laughing, and pooping all over the place over that one! At least he’s (bowel) moving in the right direction- PUN INTENDED!! Haa!!

Friday, July 9, 2010

Day by Day

Sunday: This week started by me working the holiday- something I'm well accustomed to as a PICU nurse. In all fairness, I think I enjoyed working and getting paid time and a half, seeing as we didn't necessarily have big plans anyways!! Plus, driving home in the storm validated those thoughts (sorry for all you who's barbeques and fireworks got rained out!). AND- what's more, we didn't have the SLEW of accidents we normally do!! One kid did come in after drinking a cup of lighter fluid (really, what adult puts lighter fluid in a cup on a table!?!?)....but compared to years past, we didn't have the trauma's that we could have.

Monday: DAY OFF WITH JON!! Did absolutely NO school work....Did absolutely NOT think of PICU work : )

Tuesday: 8 hours of meetings...yes, 8 hours! And then I cried for the last 4 hours of my shift! Well, I restrained....but I felt like it!

My patient was a five month old that weighed less than some newborns. She was extremely malnourished...dehydrated...but OH SO CUTE!!! Her mom is young and has six other kids at home. I guess this is her explanation as to why this baby has not been fed for the past 5 months.

Because of something called "Refeeding Syndrome" you can't just let her eat all she wants- it could literally kill her at this point! Instead, you have to introduce nutrition via IV...then add formula VERY VERY slowly.

How about holding a six pound peanut in your arms and feeding her ONE OUNCE of formula...then taking it away!! She gulped that one ounce down in about 10 seconds flat, and then looked at me with big eyes like "Why are you not giving me more!?" Oh, break my heart!! She screamed and screamed for the next hour until she was too tired, and fell asleep. Then an hour after that, the whole process started all over again : (

Wednesday: Time to get down to work: study, study, study. BUT- it paid off b/c I got an A on my test Wed. night!! Yeah me : )

Thursday: Back to work with my trach guy...and his neighbor who has been hard for me to take care of the past two weeks (as if Tuesday wasn't hard enough!). Trach guy is doing well with his trach...so now all the teaching begins with his family...that will be INTERESTING!!

Trach guy's neighbor was a 16 year old with a very large, very advanced brain tumor. She no longer is able to move, no longer able to communicate, no longer able to focus her eyes on anything. She now has kidney problems, breathing problems, and severe neurological deficits. And yet, despite being at home on hospice, to die as peacefully as she can, her mom brought her into the ED. And then we admitted her.

I have a very hard time looking at this poor girl, suffering, and thinking if her heart stops, I will be the one to push that code button and begin compressions. I will be the one to inflict pain, possibly breaking ribs, and "save" this girl....but for how long??

Now, I am not a mother. I cannot imagine having to go through this with a daughter. But I also know I could not imagine going through it myself. I hope that when I am at the end of life, those around me will be able to let the suffering end, and let me go.

Thankfully, we had 3 care-conferences with this mom over the course of the past 10 days. While I would say I have complaints that docs I work with are a little "too nice" sometimes and not able to deliver the bad news well, these doctors were very explicit and honest with this mom. At the end of my shift, I had discharge orders ready to send this poor girl home.

Friday: I did one phone triage today, although admittedly I just made a referral rather than a helpful recommendation. I don't deal with skin issues/rashes very much....at least the non-life threatening kind : ) But my referral managed to be a success, so that counts!

And finally, I went to the store to buy gifts for not one, but 2 PICU nurse friends!! Apparently, this is the time for PICU nurses to be having babies!! I wrapped one big blue gift and one big pink gift...and it got me excited for the boy/girl twins that I'm determined to have : )

So that was this PICU nurse's week! Some ups, some downs...but isn't that what this adventure is all about!?