Wednesday, March 5, 2008
purple cast
Why is everyone coming to my blog by searching for the terms "purple cast"? I can't imagine that I'm at the top of a google search for that or anything! (I just figured out how to use the site meter to see what people were typing in searches.)
Pain Scales
I was thinking about the post by Nurse K: Burn the pain scales
http://crasspollination.blogspot.com/2008/03/burn-pain-scales.html
(I don't know how to change the text on the blog so that people can click on the name of the title instead of seeing the long address. Any tips on this?)
These scales seem inherently flawed. Two examples.
56 year old with kidney stones: 4/10 pain. I would have said 7/10 easily. Sweating, tachycardia, elevated blood pressure. Turns out he was severely injured recently. Aparently pretty bad. So, his pain was undertreated in my opinion.
25 year old with "150% out of 10" pain all over (um??? Is that a 15/10?) My initial thought was maybe she has a narcotic deficiency :-). Ended up she was simply scared to death because her boyfriend's cat scratched her! It was such a minor scratch, that I had to wonder. She couldn't imagine any pain worse than that?
So, I'm curious: does anyone else seem to notice that around 7 or below, are usually truly painful conditions, and anything 10 or above tend to make you wonder if it even hurts?
How many of your 10/10's are really that serious? I'd say maybe 1 in the last month! (ruptured appendix)
http://crasspollination.blogspot.com/2008/03/burn-pain-scales.html
(I don't know how to change the text on the blog so that people can click on the name of the title instead of seeing the long address. Any tips on this?)
These scales seem inherently flawed. Two examples.
56 year old with kidney stones: 4/10 pain. I would have said 7/10 easily. Sweating, tachycardia, elevated blood pressure. Turns out he was severely injured recently. Aparently pretty bad. So, his pain was undertreated in my opinion.
25 year old with "150% out of 10" pain all over (um??? Is that a 15/10?) My initial thought was maybe she has a narcotic deficiency :-). Ended up she was simply scared to death because her boyfriend's cat scratched her! It was such a minor scratch, that I had to wonder. She couldn't imagine any pain worse than that?
So, I'm curious: does anyone else seem to notice that around 7 or below, are usually truly painful conditions, and anything 10 or above tend to make you wonder if it even hurts?
How many of your 10/10's are really that serious? I'd say maybe 1 in the last month! (ruptured appendix)
Monday, January 7, 2008
Less Optimistic? The Just World Phenomenon
Anyone have any suggestions for being...well more cynical?
Does it just take time? After a certain number of years, do you just see people differently?
The reason I first wanted to be a nurse was to care about people and make a difference in their lives. That hasn't changed.
But, I don't seem to have the expected attitude. In Social Psychology, most us hold a
belief called the just-world phenomenon.
http://en.wikipedia.org/wiki/Belief_in_a_Just_World (I'm not sure I got hyperlinks to work but I tried!
Basically that people get what they deserve.
Unfortunately, I don't believe that. I've seen too many people who are kind and caring die, or have lives so full of pain and misery that they did nothing to cause. And seen people who don't care about anyone or themselves live to a healthy old age and peacefully die in their sleep.
So how does that affect me as a nurse? I wouldn't say in a negative way. If someone needs to hear something, like that they REALLY need to stop drinking or their liver is just going to totally shut down, and they won't be eligible for a transplant, I don't shy away from telling them. But I never do it in a "tough love" kind of way. I guess, with every person (when there is time - I do get crabby when there are 20 things to do and not enough of me to do them all, and of course sometimes am judgemental...) I TRY to think "how would I want to be treated if I was in their situation". Since I am like this not only at work, family and friends have been trying to change my attitude: for example telling me "but you would never do that" or "he deserves worse after what he did". It hasn't worked. I just think "Sure, I would never do that, but look at all the resources and knowledgee I have. What if I DIDN'T have people who cared? What if I didn't know about....?"
And then it seems like people can't understand why I don't shy away from the hard things. Why I offer to take the twins with CF who are dying. Why I try to help the homeless drunk woman find some shelter, and support. I don't think either of them are getting what they deserve, I think both deserve my very best. Of course, that's humanly impossible, so I just do what I can...
but I just can't seem to join in the talk both about types of patients being annoying (yes, I do say that things they do are annoying, like why would an RN be needed to turn the lights on and off every 5 minutes when there is a perfectly healthy family member sitting right there) but I still care about the person, and wouldn't call them an annoying person. Just "I wish people had some perspective about all the other things I have to do, it was getting annoying".
So, what do you think? How long will it take for me to join the ranks of those who see tragedy only in those suffering not of their own cause, and who are kind and enjoyable to be around. And to see annoyance, dislike of the person, who has made bad choices.
Does it just take time? After a certain number of years, do you just see people differently?
The reason I first wanted to be a nurse was to care about people and make a difference in their lives. That hasn't changed.
But, I don't seem to have the expected attitude. In Social Psychology, most us hold a
belief called the just-world phenomenon.
http://en.wikipedia.org/wiki/Belief_in_a_Just_World (I'm not sure I got hyperlinks to work but I tried!
Basically that people get what they deserve.
Unfortunately, I don't believe that. I've seen too many people who are kind and caring die, or have lives so full of pain and misery that they did nothing to cause. And seen people who don't care about anyone or themselves live to a healthy old age and peacefully die in their sleep.
So how does that affect me as a nurse? I wouldn't say in a negative way. If someone needs to hear something, like that they REALLY need to stop drinking or their liver is just going to totally shut down, and they won't be eligible for a transplant, I don't shy away from telling them. But I never do it in a "tough love" kind of way. I guess, with every person (when there is time - I do get crabby when there are 20 things to do and not enough of me to do them all, and of course sometimes am judgemental...) I TRY to think "how would I want to be treated if I was in their situation". Since I am like this not only at work, family and friends have been trying to change my attitude: for example telling me "but you would never do that" or "he deserves worse after what he did". It hasn't worked. I just think "Sure, I would never do that, but look at all the resources and knowledgee I have. What if I DIDN'T have people who cared? What if I didn't know about....?"
And then it seems like people can't understand why I don't shy away from the hard things. Why I offer to take the twins with CF who are dying. Why I try to help the homeless drunk woman find some shelter, and support. I don't think either of them are getting what they deserve, I think both deserve my very best. Of course, that's humanly impossible, so I just do what I can...
but I just can't seem to join in the talk both about types of patients being annoying (yes, I do say that things they do are annoying, like why would an RN be needed to turn the lights on and off every 5 minutes when there is a perfectly healthy family member sitting right there) but I still care about the person, and wouldn't call them an annoying person. Just "I wish people had some perspective about all the other things I have to do, it was getting annoying".
So, what do you think? How long will it take for me to join the ranks of those who see tragedy only in those suffering not of their own cause, and who are kind and enjoyable to be around. And to see annoyance, dislike of the person, who has made bad choices.
Saturday, January 5, 2008
Please be yourself!
To any identical twins: it must be GREAT to be able to switch places, and I know Cystic Fibrosis is a pain so you try anything to make medical experiences more fun, but please, please don't do it in the ER, ok? You may look alike, but we really need to treat each of you...
Twin 8 year olds with CF come into the ER. They both have been experiencing increased coughing, and then the whole family gets the flu. So, off to the ER. Of course their names start with the same letter. And of course their treatment is nearly the same. IV's, nebulizers, etc. I go to hang some IV antibiotics for Emily, and notice she already has some going. I double check the bracelet, Emily sure enough. Hm, it is a slow night, maybe someone else hung the IV. I hung Elizabeth's about an hour earlier, she was really tough to get IV access on. I'm suprised she doesn't have a port. All of the sudden I notice the little mark on "Emily's" other arm from the first IV attempt on ELIZABETH. But the bracelet says Emily.
Okay, I am so glad this was caught and I didn't give one of them a double dose of medication. Or something scary like that.
"Did you two switch name bracelets" I ask? Two guilty looks. How in the world did they do it? They proceeed to show me that if they hold their hand a certain way, it tends to make the bracelets looser and then they can switch and "have some fun". Needless to say they got a lecture, bracelets that FIT, as well as a note in the chart saying double check patient - switches places with identical twin! I even got the bracelets we put on and write in severe allergies, put them on their ANKLES, and wrote their names. I wanted to write their names on them with permanent marker!
I just feel so bad for them though. Spending Christmas Eve in the ER, and it isn't even anything unusual for them. They were just trying to have some fun. But just imagine the potential problems! I think we need to have a standard question "do you have an identical twin" and "if so is she in the hospital right now?"
By the way, we finally came up with a way to tell them apart. It was a slow night, they were eventually going to be admitted (probably for one of their last times I was told. I didn't realize it was that bad.) They both have always wanted casts, but never been active enough to break bones. Emily wanted a purple cast on her right wrist. Elizabeth wanted a pink one. Well, they aren't going to be having much sucess switching places. It was so sad. I heard Emily asking her sister "Is this when they tell us we won't get better, ever?" I had to try really hard not to cry. I think the doctor was to give them casts. I did find out that their best friend had just broken her arm, so aparently that was the "cool" thing now. At least they got to do something "cool", and at least we can be sure we have the right twin. Sure wish the rest of it was that easy to fix - just put a cast on it and make it all better.
Twin 8 year olds with CF come into the ER. They both have been experiencing increased coughing, and then the whole family gets the flu. So, off to the ER. Of course their names start with the same letter. And of course their treatment is nearly the same. IV's, nebulizers, etc. I go to hang some IV antibiotics for Emily, and notice she already has some going. I double check the bracelet, Emily sure enough. Hm, it is a slow night, maybe someone else hung the IV. I hung Elizabeth's about an hour earlier, she was really tough to get IV access on. I'm suprised she doesn't have a port. All of the sudden I notice the little mark on "Emily's" other arm from the first IV attempt on ELIZABETH. But the bracelet says Emily.
Okay, I am so glad this was caught and I didn't give one of them a double dose of medication. Or something scary like that.
"Did you two switch name bracelets" I ask? Two guilty looks. How in the world did they do it? They proceeed to show me that if they hold their hand a certain way, it tends to make the bracelets looser and then they can switch and "have some fun". Needless to say they got a lecture, bracelets that FIT, as well as a note in the chart saying double check patient - switches places with identical twin! I even got the bracelets we put on and write in severe allergies, put them on their ANKLES, and wrote their names. I wanted to write their names on them with permanent marker!
I just feel so bad for them though. Spending Christmas Eve in the ER, and it isn't even anything unusual for them. They were just trying to have some fun. But just imagine the potential problems! I think we need to have a standard question "do you have an identical twin" and "if so is she in the hospital right now?"
By the way, we finally came up with a way to tell them apart. It was a slow night, they were eventually going to be admitted (probably for one of their last times I was told. I didn't realize it was that bad.) They both have always wanted casts, but never been active enough to break bones. Emily wanted a purple cast on her right wrist. Elizabeth wanted a pink one. Well, they aren't going to be having much sucess switching places. It was so sad. I heard Emily asking her sister "Is this when they tell us we won't get better, ever?" I had to try really hard not to cry. I think the doctor was to give them casts. I did find out that their best friend had just broken her arm, so aparently that was the "cool" thing now. At least they got to do something "cool", and at least we can be sure we have the right twin. Sure wish the rest of it was that easy to fix - just put a cast on it and make it all better.
Monday, December 17, 2007
Reverse Orthostatic Hypotension
Okay, I said there would be a quiz or two.
Here's a REALLY tough one to start out with. (Nursing students, don't feel bad if you don't get this one.)
Patient's vitals (each was taken after being in said position for approximately 5 min.)
Pulse did not change posturally.
1. Supine 55/30
2. Seated 91/62
3. Standing 104/72
4. Supine 60/29
Now I know there is orthostatic hypotension, but what is this?! I've googled, asked doctors, hoped the patient would come back with an answer, but I'm still waiting. Maybe I'll never know. But this is just one of those things that leaves you thinking "What is going on here!" Equipment failure and human error have been ruled out as this pattern is consistent on various automatic and manual cuffs, with at least 5 different medical professionals.
Hint (maybe): Patient presented a month ago in SVT. Put on Lopressor. Patient "felt awful at night" on it, and pulse sitting at rest was in the 60's on a QUARTER of a 25 mg tablet. Normal pulse for patient was in the 90's prior to this. Second episode of SVT, back on Lopressor.
That is just so weird. I can't find ANYTHING that says Lopressor lowers BP more when patient is supine.
Here's a REALLY tough one to start out with. (Nursing students, don't feel bad if you don't get this one.)
Patient's vitals (each was taken after being in said position for approximately 5 min.)
Pulse did not change posturally.
1. Supine 55/30
2. Seated 91/62
3. Standing 104/72
4. Supine 60/29
Now I know there is orthostatic hypotension, but what is this?! I've googled, asked doctors, hoped the patient would come back with an answer, but I'm still waiting. Maybe I'll never know. But this is just one of those things that leaves you thinking "What is going on here!" Equipment failure and human error have been ruled out as this pattern is consistent on various automatic and manual cuffs, with at least 5 different medical professionals.
Hint (maybe): Patient presented a month ago in SVT. Put on Lopressor. Patient "felt awful at night" on it, and pulse sitting at rest was in the 60's on a QUARTER of a 25 mg tablet. Normal pulse for patient was in the 90's prior to this. Second episode of SVT, back on Lopressor.
That is just so weird. I can't find ANYTHING that says Lopressor lowers BP more when patient is supine.
Welcome
Welcome to my blog! I hope you find it funny, informative, or whatever you were looking for.
Intersting phone calls of the day:
1. I can't find my Demerol. Can you call it in? (Patient is not on Demerol but I guess that doesn't stop them!)
2. Pharmacist. Patient is requesting that we refill Demerol. Patient demands that the pharmacist call.
3. Kind old lady - my blood sugar was 483 before breakfast, and 582 before lunch. I'm sorry to bother you, I was just a little worried....(Yeah, I was too!)
Pain scales:
Patient did not understand numeric rating. Rated pain as 10 in areas he felt no pain. Tried explaining pain scale. Tried smiley face scale. Patient said "none of those is making the face I'm making". Okay, tried to explain what each pain would correspond with. Patient said "Can't I just say I have no pain so I don't have to answer this?" Ended up telling the doctor that the patient stated he was in pain, seemed to me to be in pain (holding abdomen, guarding over lower right quadrant), but did not rate pain.
Now this one had me baffled:
Me: Asking if the patient had pain
Mathless: Yes, my knee
Me: Asking to rate pain on 1-10 scale
Mathless: negative 2.385
(Huh?)
I explained that negative numbers were not what I was asking for.
Mathless: okay, how about 7.297595860403858395786894949589454874878458745898459845989458945874857485748574637348589493977777777777777777777788888888888888888999999999999999999999944444444444444422222222.............etc.
I really don't think we need it THAT precise. And how pain can go from -2 to 7 is also unbelievable
Intersting phone calls of the day:
1. I can't find my Demerol. Can you call it in? (Patient is not on Demerol but I guess that doesn't stop them!)
2. Pharmacist. Patient is requesting that we refill Demerol. Patient demands that the pharmacist call.
3. Kind old lady - my blood sugar was 483 before breakfast, and 582 before lunch. I'm sorry to bother you, I was just a little worried....(Yeah, I was too!)
Pain scales:
Patient did not understand numeric rating. Rated pain as 10 in areas he felt no pain. Tried explaining pain scale. Tried smiley face scale. Patient said "none of those is making the face I'm making". Okay, tried to explain what each pain would correspond with. Patient said "Can't I just say I have no pain so I don't have to answer this?" Ended up telling the doctor that the patient stated he was in pain, seemed to me to be in pain (holding abdomen, guarding over lower right quadrant), but did not rate pain.
Now this one had me baffled:
Me: Asking if the patient had pain
Mathless: Yes, my knee
Me: Asking to rate pain on 1-10 scale
Mathless: negative 2.385
(Huh?)
I explained that negative numbers were not what I was asking for.
Mathless: okay, how about 7.297595860403858395786894949589454874878458745898459845989458945874857485748574637348589493977777777777777777777788888888888888888999999999999999999999944444444444444422222222.............etc.
I really don't think we need it THAT precise. And how pain can go from -2 to 7 is also unbelievable
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