I woke up two days ago with some pain in my right shoulder. I can't pin-point whether it's muscular or a pinched nerve. I'm leaning towards muscular because it hurts with range of motion movement. The worst pain is when I'm reaching across my chest and lifting my arm up and trying to touch my back. It was a pain (literally) to take off my scrub top today after work.
Growing up with a family of nurses, I've heard numerous body pain stories. From back pain to shoulder pain to feet pain.... you name it, a nurse somewhere hurts there! LOL. I don't know if the sore shoulder is because I slept on it wrong or pulled it during work, but it hurts. I'm only 25 and don't want to disable myself so early in life. My mom's warnings of "You only hurt your back once" and stress of proper body mechanics keeps coming to mind.
I know I've probably taken my body and youth for granted in the past, but this new pain has made the lightbulb go off. Bodily injuries can go hand in hand with nursing if you don't take care of yourself. We turn obese, immobile patients in bed. We wheel 300+lbs people in wheelchairs. We push beds that weigh twice our size. We run, jump, bend, and do cartwheels down the hall! HAHAHA. Okay, scratch the cartwheels, but many nurses have battle wounds and scars from years of physical labor. I really need to start taking better care of myself and watching out for my body... or else I might find myself in the wheelchair rather than the one pushing it :P
Thursday, October 14, 2010
Tuesday, October 12, 2010
IV Push Can Be Scary!
Okay, so most aren't too bad to give and you literally just push the medication into the heplock access; like a Heparin IV boluses. A lot of medications given IV push, however, require the nurse to be aware of how many mg/min you administer. Example, 2mg of Diluadid (a pain killer) needs to be diluted with at least 5ml of normal saline and then pushed into to the IV over 2-3 minutes, PLUS you need to follow each IV push with an equal amount of a normal saline flush at the same rate.
How fast you push the medication can have ill effects on the patient. I remember from nursing school my instructor making a big deal about how if you give Lasix IV push too fast, you could cause your patient to go DEAF! That always stuck with me. I have yet to push Lasix, but I did have to push IV Dilantin last week.
Funny thing about Dilantin... it's suppose to help in preventing seizures, but if you push it too fast YOU COULD CAUSE YOUR PATIENT TO HAVE A SEIZURE!!! As noted from my preceptor, the previous day she gave the patient Dilantin push at a rate of 50mg/min. She got this rate from one of the drug handbooks on the unit. But our pyxis machine (holds and dispenses medications) warned to administer at a rate of 25mg/min. When I asked my preceptor, which rate I should use she said, "Let me put it this way, after I gave the patient Dilantin yesterday, she had a mild seizure". WTF?!?! Well, that made up my mind. Even though it was going to take me 8 mins to administer 4mls of this med PLUS another 8 mins to flush with normal saline, I didn't want to risk my patient having another seizure! It seemed like the longest 16 minutes ever!! Thankfully the patient was not alert or oriented (her brain had been fried after being in a diabetic coma for 2 days), and THANKFULLY she did not have a seizure!! Let me tell you though, every time she twitched her legs I prayed "please don't seize! please don't seize!"
Well, that was one of the more interesting (to say the least) medication administration experiences I have had. I'm sure there will be plenty more to come! Just wait for the day when I have to push Adenosine... that should be quite the story, as it would be for anyone :P
How fast you push the medication can have ill effects on the patient. I remember from nursing school my instructor making a big deal about how if you give Lasix IV push too fast, you could cause your patient to go DEAF! That always stuck with me. I have yet to push Lasix, but I did have to push IV Dilantin last week.
Funny thing about Dilantin... it's suppose to help in preventing seizures, but if you push it too fast YOU COULD CAUSE YOUR PATIENT TO HAVE A SEIZURE!!! As noted from my preceptor, the previous day she gave the patient Dilantin push at a rate of 50mg/min. She got this rate from one of the drug handbooks on the unit. But our pyxis machine (holds and dispenses medications) warned to administer at a rate of 25mg/min. When I asked my preceptor, which rate I should use she said, "Let me put it this way, after I gave the patient Dilantin yesterday, she had a mild seizure". WTF?!?! Well, that made up my mind. Even though it was going to take me 8 mins to administer 4mls of this med PLUS another 8 mins to flush with normal saline, I didn't want to risk my patient having another seizure! It seemed like the longest 16 minutes ever!! Thankfully the patient was not alert or oriented (her brain had been fried after being in a diabetic coma for 2 days), and THANKFULLY she did not have a seizure!! Let me tell you though, every time she twitched her legs I prayed "please don't seize! please don't seize!"
Well, that was one of the more interesting (to say the least) medication administration experiences I have had. I'm sure there will be plenty more to come! Just wait for the day when I have to push Adenosine... that should be quite the story, as it would be for anyone :P
Saturday, October 9, 2010
Keep Holding On
Wow, I can't believe I'll be going into my 4th week (a month!) as a nurse. I don't think it has fully hit me that I'm a NURSE! I think it might be because I'm still orienting and feel as if there is sooo much still to learn.
I love my job and while nursing is hard and not for everyone, I think it's one of the most rewarding jobs out there. As a nurse you are constantly learning, evolving, and growing. Not only do you learn new things everyday, but get to meet new people too.
This past week I had a patient who really stands out in my memory. She was a lady who had suffered from a diabetic coma for two days before anyone knew and found her. It's amazing that she was even alive. In layman's terms, she's a diabetic and her blood sugar reached dangerously high levels that she passed out due to dehydration; too much glucose surrounds the cells and the concentration gradient causes water to be pulled out of the cells in an attempt to balance things. This extra water is excreted by the kidney out of the body as urine. In this dehydrated state, cells such as brain cells cannot function and eventually lose the ability to function.
The result: my patient is not alert or oriented. While she opens and closes her eyes when she's not sleeping, she is in a constant far off gaze. She doesn't follow you with her eyes as some stroke or brain trauma patients do. She doesn't respond to painful stimulus. She doesn't talk or move voluntarily. She has trach in her throat because she cannot consciously get rid of the sputum/spit that builds in her throat. Likewise, she cannot chew or swallow so she has to receive nutrients and medications through a PEG tube (a tube that goes into her stomach). What a life. And will she ever get better? I believe that miracles do happen, but logic and statistics argue differently.
But she IS still alive. Parts of her brain still function to keep her breathing and her heart beating. She is still a person; a human being. And as a human being deserves to be treated with dignity and respect. Even though her random movements and jerking of her arms and legs, her opening of her eyes and yawning give her family hope, it's sad to think that that's all it could be. Just hope.
As a nurse, you are trained to think critically and logically. We work in a field driven by medicine and science. Yet, we also deal with issues of culture, emotions, and spirituality. We deal with life. And even though my education tells me that this woman will always remain in this flaccid state of limbo... those rare moments when she smiles at me also give me hope :)
I love my job and while nursing is hard and not for everyone, I think it's one of the most rewarding jobs out there. As a nurse you are constantly learning, evolving, and growing. Not only do you learn new things everyday, but get to meet new people too.
This past week I had a patient who really stands out in my memory. She was a lady who had suffered from a diabetic coma for two days before anyone knew and found her. It's amazing that she was even alive. In layman's terms, she's a diabetic and her blood sugar reached dangerously high levels that she passed out due to dehydration; too much glucose surrounds the cells and the concentration gradient causes water to be pulled out of the cells in an attempt to balance things. This extra water is excreted by the kidney out of the body as urine. In this dehydrated state, cells such as brain cells cannot function and eventually lose the ability to function.
The result: my patient is not alert or oriented. While she opens and closes her eyes when she's not sleeping, she is in a constant far off gaze. She doesn't follow you with her eyes as some stroke or brain trauma patients do. She doesn't respond to painful stimulus. She doesn't talk or move voluntarily. She has trach in her throat because she cannot consciously get rid of the sputum/spit that builds in her throat. Likewise, she cannot chew or swallow so she has to receive nutrients and medications through a PEG tube (a tube that goes into her stomach). What a life. And will she ever get better? I believe that miracles do happen, but logic and statistics argue differently.
But she IS still alive. Parts of her brain still function to keep her breathing and her heart beating. She is still a person; a human being. And as a human being deserves to be treated with dignity and respect. Even though her random movements and jerking of her arms and legs, her opening of her eyes and yawning give her family hope, it's sad to think that that's all it could be. Just hope.
As a nurse, you are trained to think critically and logically. We work in a field driven by medicine and science. Yet, we also deal with issues of culture, emotions, and spirituality. We deal with life. And even though my education tells me that this woman will always remain in this flaccid state of limbo... those rare moments when she smiles at me also give me hope :)
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