Friday, January 18, 2008

Atrial Flooder

I'm in the midst of my geriatric rotation. We're on a telemetry floor and so there's lots of talk floating around about how to read the EKGs: Is it a second degree block or is that atrial flutter (I was really tired during report and I wrote "atrial flooder" in my notes.)? Could it be a winky-bock? (No, that's not how it's spelled, but I like it better that way) Is that two P-waves? I can't keep it all straight and all of these things might be the same thing. I was just happy to be able to point to an EKG print out and describe the mess of lines at one part as "artifact" (that's stuff that is not meaningful and happens when a patient is wiggling around excessively, say). When I'm bored I go hang out w/ the EKG tech and ask 'em questions:

( "So, uh, do you get hypnotized watching all of these patterns?" And this one got a really good answer and I suddenly really liked the fellow and my respect for EKG techs multiplied by, like, 150. "No. Because I put a lot of the leads on the patients myself and I know what heart meds they're on, and I know w/ Mrs. K. here that when her heart rate drops to 35 it's OK unless it stays at 35 and I know that 110 is a normal rate for Mr. H. over here." In other words, he was connecting these squiggly green lines on the screen w/ the patients behind them and he was paying attention.)

I hung out and got to be "Nurse Leader" tonight w/ a fellow student. That meant, essentially, that we got to help other students and nurses on the floor w/ their patients, but it mostly meant that we spent a lot of time looking stuff up using the other student's HUGE number of resources. She had books; some flippy ones that were in her pockets and some bigger ones that were in her backpack. Most of the books had handy and colorful tabs on the side labeled as "IV" "pediatrics" "procedures" "emergency" and other handy things. She had a palm device (um, a Palm device maybe) w/ a poke-y stick that she tickety-ticked w/ and all kinds of useful info came up: Yes, Haldol can cause neuroleptic malignant syndrome. Here's a third degree heart block EKG, right here, see? SHUT UP: cranberry juice can interfere w/ coumadin? It made me aware that I'm under-info-packed out there on the floor. I have a barely-used flippy RNotes crammed into my backpack and sometimes I'll bring my drug book.

It was a good night, though. Monday was a hard night. After I took care of my patient, went to dinner and came back her family told me they didn't want students taking care of their family member anymore. Um, OK. They wanted someone more efficient, apparently. Sigh. I went home and fretted about all of the things a student nurse, mom and all around busy person frets about and cried and now I'm feeling better, but mostly it's because it's a three day weekend and I might have time to relax and clean the house and do some extra-curricular reading on heart arrhythmias. See, I know how to have a good time!

Thursday, January 10, 2008

Wheeeeeeee! Care Plans!

No. That's not one of my cakes. There's something really odd about brown roses, but I will admit that I had the cake commissioned from Costco and the sentiment is what counts there. Of course, this was one of the cakes from our holiday party so the quarter is not now over. It was over then. Now I'm up late tippity typing away on a care plan. Somehow -and I don't know how- I've never done a care plan for someone who's had a myocardial infarction (that's a heart attack in common vernacular). I've danced around MI: I've done CHF. I've done atrial fibrillation. And who of my patient's hasn't had kidney failure related to high blood pressure? Arrythmias? check. Dysrythmias? check. OK: quit paying attention; they're the same thing. I know.

Here's the thing. I like doing care plans. Sorta. I like having the info about the disease all tidily written up. I like to have a list of the signs and symptoms. I'm a fan of the knowledge of complications and nursing interventions. I *really* want to know what the side effects of my pateint's medications are. It's good stuff and I go into my patient's room and am as semi-on-top of what's going on as a nursing student can be. So why are we nursing students always complaining about these things, these care plans? We-e-e-e-e-llllllll...A big part of it for me and perhaps you, my fellow nursing students, is that you have to spend hours and hours hunched typing at a computer w/ half of your nursing texts splayed in your lap, on the table behind you, on the window seat next to you and w/at least three web pages open from drug manufacturers and disease support group sites and all. It's a logistical nightmare and then it's also a formatting nightmare. I've always felt halfway computer savvy, but I'm constantly changing font sizes, adding or removing columns from tables and trying to make text fit where it doesn't want to. These monster crazy-quilt formatted things crash my computer every other sentence so I've become a nervous wreck w/ the CTRL-S. It's my care-plan-doin' nervous tic. And then there's all the "See Attached's" that I'll have to staple on later. And this is just the pre-care plan fun. The care plan itself with the activities and the analysis is where my fiction-writing skills need some special honing. I have to have goals and they have to be measurable and they have to be run through this systems theory machine created by past instructors at Nursing School U *and* it has to make sense and a lot of times I'm in there with my patient just trying to address the three million things that pop up in their day. Ooops. Plan. What plan? It only works out about half the time and I'm being pretty generous there. So. Um. That's a problem. Hurray! The quarter's over! ... in 10 more weeks.

Friday, January 04, 2008

Back Atcha

It's back to school on Monday. *sigh* I barely had time to slouch horizontally on the floor, drool and read fiction whilst watching bad television and eating chocolate "bon bons" (those'd be from the 10 pound bag of Hershey's kisses left over from the holiday party we (the Nursing Student-y Organization that I'm a part of) threw for the nursing students and staff). I was barely able to take the kids to holiday-flavored events and locations and now I have to go back. I spent most of the break coping w/ my badly-removed tooth and the perplexing and constant issue of Toy Storage that always comes to a head 'round about now.

This quarter I'm doing my geriatric and my pediatric rotations. Most of my clinicals have been pretty geriatric, actually. Everyone in the hospital these days is elderly, it seems. And a lot of 'em smoke, or are obese or are drinkers. I'm not being cynical. These are just observations. Someone back me up here. I'm actually looking forward to going back despite the list of things I didn't do at home, the things I didn't bake and the parks I didn't take the kids to. *sigh*

Pictured above is the ice cream sundae I made for Christmas. The ice cream is from one of the best ice cream places in a town of good ice cream places. Yes, it's mint ice cream and the color comes from ground up mint leaves. It's topped w/ hot fudge (recipe follows) and whipped cream and pulverized candy cane because -darnit- if it's not sprinkled w/ pulverized candy canes in December it might not be worth dipping a spoon into!

Hot Fudge Sauce

1 cup heavy cream
1/2 cup corn syrup (hey, can any of you find corn syrup *w/out* added vanilla?sheesh!)
9 ounces fine quality bittersweet chocolate, finely chopped
1/3 cup dark brown sugar
good pinch of salt
2 Tbsp butter (skip adding salt if using salted butter, but you wouldn't use salted butter would you?)
1 tsp vanilla

Bring cream, corn syrup, salt and chocolate to a simmer in a heavy saucepan over low to medium heat. Once it's bubbling, turn down the heat and cook for five minutes. Stir it half as often as you think you should. Remove from heat and add butter and vanilla. Cool to warm before serving. You can refrigerate it and heat a little bit up until shiny before serving.

Note: a lot of recipes will lecture you about "breaking " your chocolate sauce. This is when the solids and the oil separate. Apparently, these grumpy bakers believe this will lead to a grainy sauce. Every time I make a chocolate sauce it breaks and I just cool it in the fridge and whisk whisk whisk until it comes together and I have never had a problem with poor there!