Friday, February 16, 2007
The Isolation Ward
Every week we get to pick a new patient. It's a little frantic...A bunch of us descend upon the Skilled Nursing Facility at the same time after our skills lab and scramble through the "cardex" looking for patients who are going to be there the whole week and who, ideally, have problems we comprehend. It's either luck or an art form, but three students out of eleven had their patients go home by Thursday. The other fun part about picking a patient is deciphering the patient's file. These things usually weigh about twenty pounds and every one of them is different. Sometimes, it's pretty easy to figure out what they're "in for". A lot of times the medications take several pages to list. And where is the "nursing language" class? LOC? Is that Loss Of Consciousness? Is that Locus of Control? Level of Care? Laxative of Choice? All of the above? You betcha!
So, I picked a "bad patient." I panicked. I wanted to pick someone who looked like they'd be there all week and I picked a patient recovering from MRSA (methicillin resistant staph aureus) sepsis and who had T-cell lymphoma. She was in the isolation ward. When I got there the next day, she was barely conscious. I was ready in my plastic gown and gloves to give her a bed bath, when the occupational therapist called out to me, "Oh no, she needs to do her ADLs [activities of daily living]." Uh. OK. This woman can barely move. And, not only that, but apparently T-cell lymphoma makes a person itchy. VERY itchy. My patient had bloody lesions all over her body from scratching (my care plan will correctly id them as "excoriations" and I'll have them listed in a range of measurements from 3-7 mm). And my patient was 5'7" and weighed 160 pounds. I'm almost 5'1" on a good day. So I had to get my patient out of bed and into the wheelchair, And then off of the wheelchair and onto the potty (oops, too late, Code Brown). And back into the wheelchair and back into bed and then, says the occupational therapist, "Oh no, she can't be in bed. She needs to sit up in the wheelchair." And, here's the suck-y thing about the isolation ward, you can't leave the room in the gown, you have to take it off, take off the gloves and THEN you go find help. It took several heftings of my patient before I realized: I can't do this. I can't move this woman by myself. So, every time I needed to move her somewhere, off goes the gown and gloves, out to the hall to track another student down (heh, heh, can't hide from me: white scrubs REALLY stick out), new gown, new gloves and on the count of three up she goes.
Somehow I made it through the clinical. I got to school and I realized: shoot, I helped my patient put underwear on and she had a catheter. That's got to be contraindicated! I'm the worst nurse ever. What if it prevents the urine from draining? What if she's really uncomfortable but too out of it to say anything? What if I get thrown out of the program for being an idiot? I went home. I finished my care plan: 20 diagnoses and Impaired Physical Mobility. On Tuesday she could barely lift her head, but on Thursday, she got up out of bed and walkered her way to the bathroom! I hadn't killed my patient! She was much better (despite another Code Brown on her wheelchair) and my Expected Outcomes? Out with the contaminated gloves. I was just hoping she'd sit up in her wheelchair for an hour. I told my patient I was proud of how much she'd improved. Maybe I can be a nurse.
This is an easy recipe. It produces a tasty yet sturdy cookie. I made about 150 of them for my daughter's 100 Days of School Celebration.
3 1/2 cups AP flour
1/4 tsp salt
1 tsp baking powder
1 cup chilled butter
1 1/2 cups sugar
2 large eggs
2 tsp vanilla extract
sanding sugar (or just extra white sugar) or royal icing
Whisk together flour, salt and baking powder. Set aside.
Beat butter and sugar using paddle attachment. It'll take little while, but beat until creamy. (I think the chilled butter makes a flakier cookie without compromising the structural integrity)
While beating the butter and sugar, whisk together the eggs and vanilla. Drizzle slowly into the creamed butter and sugar with the mixer on low. Combine. Add flour half the flour and combine. Add the other half. (Heck, you could add it all at once, but if I do I get a huge flour cloud).
Divide dough in half and wrap in plastic, fridge for an hour.
Line two cookie sheets w/ parchment paper. (you don't have to, it just makes the cookies so much easier to remove)
Roll one dough blob on a lightly floured surface with a lightly floured rolling pin. 1/4 is a good thickness. Cut out cookies. put on cookie sheet. If you're not using icing, sprinkle with sugar.
Bake for about 10-12 minutes or until just brown around the edges. Leave them on cookie sheet for a few minutes and then transfer them to a wire rack for cooling.