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!!

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.

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!

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!!!

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!!

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 : )

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!