Friday, July 27, 2012

APN Bootcamp

So this week we had APN Bootcamp.  Time to whip my PICU booty into shape!

Sounds kinda intimidating, huh!?

I was actually kinda nervous going into it, mainly because a majority of the time we were in the simulation lab where all kinds of scary can happen!

But it wasn't so bad.

And it was even kinda fun!

I successfully intubated a baby for the first time (first time to try, not first time successful)!  A SIMBaby that in one that doesn't really breath, or have a real heartbeat, but hey, I'll take what I can get right now!

We also got through a full code in one of the PICU rooms, and didn't kill our dummy, so that's always a bonus : )

There were lots of lectures about communication and how to really speak up to give our patients the best possible care.

And of course there are plenty of scenarios using SimLady and SimBaby that can talk by the man or woman behind the window.  There's nothing like talking to a plastic patient, and having them actually talk back!

So time to enjoy a fun weekend with the family after an exhausting week of bootcamp!  Hope you all have a relaxing, fun weekend without work!

Monday, July 16, 2012

Back to Nights...and other ramblings

Today's post will be a quick one because I am back to working nights this week.  I'm still trying to figure out what routine will work best for me on the first night that I work.

Do I wake up early and have a better chance at taking a nap? Or do I sleep in and just assume I'd probably not get a nap in anyways!?

Do I just chill until I leave at 2, or should I be more active in the morning, get a little sleepy and then lay down for a bit?

I don't think there's a right answer for now, so I'll just do whatever comes to mind today.  Unfortunately that started with an early morning dentist appointment that still has the entire right side of my mouth and cheek completely numb!

Hopefully that wears off before I start my shift...patients don't want an APN looking like she's having a stroke because one side of my face doesn't move when I talk, laugh or smile!

But I leave you with something funny.  Every time I drive home from work, I pass this cemetery by, and without fail, makes me laugh!

I wish I had a better zoom on my camera phone...I'm not sure if you can see what the sign says.

Sign on cemetery fence: "Come Worship with Us!"  And then it proceeds to list times for worship, Sunday School and Adult Bible class.

There must be a church hiding somewhere back there, but it is certainly not visible from the road!  Until then, I keep laughing that those in the cemetery are inviting us to their weekly worship!  Creepy!

Here's to hoping that tonight's shift won't be equally as creepy!  And for those of you that are night shift pros, I'd love to hear your tips!

Friday, July 13, 2012

The Day I felt like a Dummy

Ever have those days...those weeks that you just feel like a dummy!?

Yeah, that would be me today!

It's July which in hospital speak means all new fellows and a new class of residents.  In RN speak that always meant "Argghhhhh!!!!!"

I haven't decided what that means in APN speak just yet...but I'm sure I will.

Anyways, along with the new PICU fellows every year comes lectures on things we should know to be successful medical professionals.

So today's lecture was: "Basic Principles and Pathophysiology of the Respiratory System"...sounds riveting doesn't it?

Unfortunately, the majority of what I understood was the words in the title.

I am pretty sure that for part of the lecture, ancient Hebrew or some little known dialect of Korean was spoken.  There were all these equations and big medical words that I had never heard of before.

So I have a lot...a LOT...of learning to do.

But what was funny was that one of my preceptors who has been in the PICU for about 10 years leaned over and said "Does that make sense?" to which I simultaneously thought "Not a chance" but said "Uh-huh!"


Of course, right in the middle of the lecture is not probably the best time to say, "Nope, don't really understand 75% of what is coming out of her mouth...can you translate it in simple new APN terms for me?"

So "Uh-huh" it was!

At the end of the day, it all goes back to being a new APN means a whole lot of learning to do.  And sometimes that means feeling like a real dummy.

Guess I'll start with my version of "Basic" and go from there, which I'm pretty sure is miles away from the "basic" being taught today! But ya gotta start somewhere!

Wednesday, July 11, 2012

When a headache is just a headache

I took care of a patient this week who was 13 and came in with altered mental status that started with a headache while playing basketball, and was severely hyponatremic (very low sodium levels).

I took care of him a few days after he was admitted, and other than being weaned off his 3% sodium drip, he was back to baseline.

Until he got a headache again in the afternoon.  The bedside nurse paged me and told me that mom was very adamant that I come immediately.

I went to examine him, and the nurse was right: the mother was just shy of freaking out.  And I guess I can't blame was a headache that started his whole initial downward spiral that led him to going unconscious and getting intubated for a day.  She was telling me "The doctor at the other hospital ER told me that with him, a headache will never just be a headache" to which I had to think, why do people say these things sometimes!?

I get that in that circumstance, the headache was an initial indicator of other serious underlying issues, but sometimes a headache is just that...a headache!

And to prove my point, the patient kept rolling his eyes the more his mom was talking.  When I asked how bad his head hurt, he said 3/10.  And then he proceeded to tell me that his head only started hurting after he was wrestling with his 8 year old brother, his 3 year old sister was running around the room screaming for 15 minutes, and his 9 month old brother "made the biggest stinky ever"..."That would make anyone's head hurt!"

I completed his exam and told the mom that it was completely reassuring.  I told her all the things that made me not concerned with this headache, and things that I thought would help alleviate it completely, including some tylenol, no more wrestling, quieting the screaming toddler, and yes, that diaper STUNK...get it out of the room! Not that a stinky diaper alone would make a head hurt necessarily, but no reason to keep something so vile in a sick patient's room!

Before I left, I asked the patient if he had any more questions.  His answer:  "Yeah...can you please tell my mom to stop freaking out!? I told her it was just a little headache, and if my brothers and sisters would just leave, it would go away.  But she went crazy and had you running over!"

To which I answered, nope, I can't do's a Mama's job to be worried like that.  

And it's my job, as the APN, to help the worried Mama understand that in this circumstance, his headache was just a headache.

I left the room with a much more calm, reassured mother.  Job well done to the both of us!  

Sunday, July 8, 2012

Co-workers will make you or break you...

and my co-workers are making me!!!  Making me into a pretty decent PICU nurse practitioner!

I must say this has been a crazy transition from nurse to nurse practitioner.  But I have thoroughly enjoyed it largely because of the great people that I work with!

Several times this week I have gotten compliments from physicians or other APNs at how well I'm doing.  A few came after some rather rough conversations in which I felt like a maybe they were just trying to build me up.

But what great co-workers! Instead of making me feel like an even bigger dummy, they compliment me!

And yesterday I presented one of our really sick patients and the liver/GI team was there.  The liver team is notorious for interrupting PICU rounds and making it a bit painful for the person presenting.  After a couple of interruptions, the PICU fellow spoke up for me.  She said "Dana has all the information, and she's presenting it in a clear, logical manner.  Let her get through the presentation, and if at the end some of your questions or concerns are not address, we can discuss it then."

There were not any interruptions after that.  And yes, I probably should have spoken up for myself, but it was nice to not even have to.

That's how great my co-workers are!  I am one lucky PICU APN!

Wednesday, July 4, 2012

Fancy Fruit and Fireworks

Happy 4th of July!

To all my nursing friends that had to work today, I hope that you didn't have to work too hard.

I on the other hand, did not work all!  It was truly a relaxing a fun day with my hubby.

We slept in, had coffee leisurely in bed, and then headed out into the heat for some soccer.  Which really just turned into passing the ball around because it was just TOO hot to be running!

Then we came home for some awesome grilled black bean burgers and beers.  And then I inflated my little 2 man boat and filled it with water, to make my very own personal plunge pool.  It was fantastic, to enjoy the sun and outdoors, but stay cool at the same time!

And then we relaxed some more.  Tonight, it's movie time.  But not before we grilled yet again (this time chicken and red peppers) and a nice tossed salad.

AND grilled peaches.  Oh MY!  These were GOOD!!  I've seen a few magazine articles lately about grilling fruit, so I thought we'd give it a try.  And this is a winner!

Plus, it was super simple.  I looked up a few recipes and just took bits and pieces of the ones I found to make what I thought sounded the best...and these did not disappoint!
1.) Cut the peach in half, and take out the pit.
2.) Melt a little bit of butter and add cinnamon and a dash of rum.
3.) Coat both sides of the peach with the butter mixture.
4.) Grill on each side for 4 minutes.
We ate these plain, but they would be absolutely AMAZING with a scoop of vanilla ice cream, or even some homemade whipped cream! YUM! 
 And what's some good grillin' without a handsome grill master!?

So it has truly been a happy, if not super relaxing, 4th of July!  And really, with all the stress and craziness of the PICU, what APN could ask for more!?