Tips for ICU patients and families

I wish all my patients and their families would follow a few simple guidelines...would make life easier!

In appreciation of critical care nurses...

I keep seeing these posters and felt compelled to make one for ICU nurses. We rock!

Awesome Day at Work!

So...in non PV-related news, I had an awesome day at work today! I took care of two patients (one sick and one not-so-sick). The not-so-sick one was an adorable older gentleman, while the sick one was trying her best to keep me on my toes! At one point her BP skyrocketed from the 120s to over 200, while her heart rate dropped waaaaay down. Then, later on...she decided to raise her heart rate sky high and drop her pressure. It was a wackadoo day, let me tell ya. We got her somewhat squared away, though...hoping she doesn't give the night-shift RN too much trouble. Needless to say, I was G-L-A-D to be done for the day!

Annnd, this may sound goofy, but I got to help a co-worker out today! I am finally getting familiar enough with things that when someone needs help I can be somewhat useful. This is HUGE in the ICU, as we rely on our colleagues so very much. It's been very important to me that I be a contributing part of the team and I'm starting to feel that way...even if it's just a little bit at a time.

Speaking of work, I am moving to night shift in four weeks or so. I guess it's inevitable, so I might as well welcome the idea. More details when I'm not so freakin' tired!

Hugs to all!
Mo

Honk if you love my blog.

Hey friends and fam...I don't update this much because I am not sure anyone else reads it. Probably due to the fact that I have my privacy settings set to "If I told you, I'd have to kill you." Anyway...if you've been in touch with me at all lately, you know I landed my dream job in the ICU. It is all kinds of awesome!

In other news...dealing with some troubling blood work but am trying not to get too freaked about it. My red blood cell count is high which means I've got a horrible disorder or I'm pretty darn dehydrated. I'm going with dehydrated and as a result am drinking a ton of water...I downloaded a little app for my iPhone called Water Tracker. It's pretty neat...you can set random reminders throughout the day that say, "Hey, drink some water!" I've set my goal at 12 8-oz glasses and have done good for two whole days in a row! Apparently it takes a bit to reverse chronic dehydration, so I'm going to stick with it until I get my next blood test. I also have super high platelets, which can also be a horrible disease or an iron deficiency. Since my ferritin levels came back low, I'm hoping that's the reason for it and not Something Else. Tom (and everyone else) thinks I need to eat beef every now and again...and honestly, I probably would because this shilolah is scaring me awfully bad. However, I'd like to try alternatives first...and one of the things I've been reading about is celiac. Apparently, a significant number of people who are diagnosed with celiac have NO gastrointestinal symptoms at all....they get tested for it because they have iron-deficiency anemia (like moi). With that said, being a vegan AND following a gluten-free diet would be rather restrictive, and I may have to throw something back into the mix to replace my beloved seitan (which is 100% gluten and one of my all-time favorite things). Sigh...we shall see. I just want to get this blood work back to normal so I can stop lying awake at night thinking about all the horrible things that can happen. And I also may have a B-12 deficiency...I'm telling ya, I am one really untalented vegetarian! I am sure my doc will do more tests, so stand by...if anyone is out there, that is.

In other exciting news...Tom and I found a little house we'd like to buy. It's two streets over from us and is absolutely darling! It would make a great little rental. Not sure we have enough saved for a down payment yet, but T is supposed to call a lender tomorrow and get some ideas. I may have talked him into staying in this house, but there are some things I'd like to do to it to get it more organized and functional. Namely, I'd like to turn the office into a humungous walk-in closet. That would be The Most Awesome Thing In The World. It would also cost Way Too Much Money, but could possibly be a fun DIY project. We'll see...need to buy the little rental first, so stand by.

Oh, speaking of buying things, I bought a new car. Or rather, I committed to buying a new car. It is enroute from some mysterious place and will arrive on the 20th...only 16 days away! Yippee! It's a white Subaru Impreza hatchback. Super super cute. I'll take pics once it's in my hot little hands...or maybe a video using Tom's dorky GoPro camera. YouTube here I come!

Ok, that's enough rambling...do me a favor and post a reply if you are still reading. I'd kind of like to see which of you I've suckered into following this almost non-existant blog.

Love and hugs,
Mo!

Is there a hematologist in the house?

Before I graduated from nursing school, I told myself I would blog more often...especially about the trials and tribulations of my first year as a nurse. Ha. I've been way too busy, way too exhausted and way too overwhelmed. I've been working at my new job in the ICU for eleven weeks and this is the first time I've even felt like sitting down to write about it. But, truth be told, that's not what is on my mind this morning...I am dealing with some troubling lab results and that seems to be all I can think about.

I went in for my annual "girlie visit" and asked the NP about getting my cholesterol screening done. She said she'd like to throw in a CBC and chem panel as well, so I said, "sure"! You know how us ICU nurses love data...the more the merrier! So I get my results back and started with the cholesterol (excellent), worked through the chem panel (fine and dandy) and then got to the CBC (not awesome). The results are troubling and I am wracking my brain trying to "self-diagnose" myself into a non-terrifying explanation (I've since had a follow-up draw, so that's the second set of results):

WBC: 10.2, 10.9 (normal...whew!)
RBC: 6.56, 6.66 (range 3.6-5.7)
Hgb: 17.1, 17.2 (range 11.5-15)
Hct: 51.8, 51.9 (range 34-46)
MCV: 79, 78 (range 80-100)
RDW, RBC: 17.5, 18.5 (range 11.9 - 14.3)
PLTs: 859, 858 (range 140-400)

Of course, I made a little diagram showing all the possible causes for each of these results (per my lab book, so probably only a portion of the possible causes, but I had to start somewhere). The happiest, very best explanation for the elevated RBC & Hgb would be that I am chronically, chronically dehydrated. I know I don't drink enough water...I absolutely know it. I am hoping like hell this is the reason. The other possible cause is polycythemia vera, for which there is no cure. Even if I don't have PV (and knock on wood that I don't), a RBC and Hgb this high is pretty scary...stroke, organ dysfunction and pulmonary embolism have all been circling around in my head for days. Sadly, as a nurse, I know just enough to scare the crap out of myself...but not enough to be reasonable and rationale.

Moving on to the high PLTs, I've been hoping against hope that I have an iron-deficiency anemia (because, trust me, the alternatives are way cruddier than that). AND THIS JUST IN!!! I just got a lab result back and my ferritin level is 9 (normal is 22-291)!!! Ok, normally this would be huge cause for concern, but I feel like this is something I can control. The other possible causes (things like cancer, polycythemia vera, rheumatoid arthritis, inflammatory conditions, chronic heart disease, cirrhosis, essential thrombocythemia, leukemias, pancreatitis, TB, ulcerative colitis) are super scary.

The thing that's throwing me is that with I.D. anemia, my RBC and Hbg would be low...but possibly the dehydration is causing such hemoconcentration that it appears high despite the anemia? I did have microcytes...which is also a sign of anemia...so I don't know. I am definitely feeling better about things than I did when I sat down to write this, but I am pretty sure my doc will send me to a hematologist. In the meantime...I'm upping my water intake to 12 glasses a day and eating iron-rich foods. I've been a pretty lazy vegetarian for a while now, and am hoping I won't have to resort to eating meat. Hoping I can just get back to eating lots of greens and such...we shall see. This is scaring the pants off me, so I will do whatever I need to do to get healthy...even if it involves eating a cheeseburger. Let's hope it doesn't come to that.

Only two more weeks!

Well, the end of the semester is upon us folks. Only two more weeks and then I'm FREE for about a week and then summer school starts. Don't get too excited..I'm only taking one class and it's a theory type class for which I have to write a 5,000 word paper about a clinical case I had. I get the feeling there's going to be some creative license taken with this one. But anyway...

The good news of the day is that clinicals are finished for this semester! Had my last day in OB last night in the L&D unit. I saw one vag and one C/S...I have to say I prefer watching the C/S than the vag births. Let's just say I'm one of those people who is very sensitive to odors. I really have to get over that...anyone have any good tips? And no, breathing through my mouth does not work because then I can taste it. Or at least I think I can.

What else? Oh, I have my meeting today about preceptorship and I'm pretty sure I've come up with a game plan. I don't think I'm going to go with the ICU and there are a few reasons for this. 1) I need to go to the unit that will make me the most marketable for the highest number of jobs. M/S wins that one hands down. 2) I really feel like I need to learn the basics before I jump into the complicated stuff. I am serious when I say I am a baby stepper...if you saw the way I learned how to do a backward dive, you'd understand (I stood on the pool ladder and dove back from there, gradually going up each step of the ladder until I could do it from the side of the pool)...that's pretty much how I approach big scary things and so far it's worked well for me...i could do a backward dive like nobody's business!. M/S definitely wins on that one as it's a great way to get a solid foundation in nursing. 3) I feel that if I do M/S first I can branch off from there and go anywhere, and at this point I am very undecided about what I want to be when I grow up. Maybe ICU, maybe ER, maybe a transplant unit. Sigh...I wish there were three of me. 4) I seriously need to learn how to be more organized...I honestly feel that learning to juggle a full patient load on a busy unit will be one of my greatest challenges...If I can do that, I can do just about anything!

Ok, small confession...I sometimes wonder if I like the ICU because it doesn't make me feel like a chicken running around with its head cut off. Yes, I dig all the complicated pathophysiology, nifty gadgets and the ability to watch my patients like a hawk...but I also like not running around like a chicken with my head cut off. I kind of feel like I need to get past the chicken head stage before I'll feel confident enough to move to more critical patients. Does that make any sense at all? Besides...who's to say I can't read my text on Critical Care Nursing regardless of where I work? Hmmm?

Meeting today at 3:30...stay tuned to see where I've decided to go!

Peds almost done, OB here I come!

This coming week is a week of lasts...my last week in Peds, my last week EVER of having to go to the hospital to pick a patient, and also my last week EVER of doing pre-clinical prep. And you can bet your sweet tookus there's a bottle of champagne chilling in the fridge to celebrate the moment I finish my last write up. I am soooo excited to be done with all that prep work...we don't choose patients the day before in OB and we don't do it with preceptorship either. This is the end of an era folks...the end of the stress, the concept maps, the sick feeling that I surely missed something. I. Can't. Freakin'. Wait!

So, let's see....school is going well. Got a 96 or so on my first peds exam and a 95 on my second OB exam. Woo hoo. We've got a Peds test coming up this Friday and I really should be studying for that instead of listening to 5-0 radio (police and fire scanner app on the ol' iPod) and updating this blog. But I am seriously suffering from senior-itis and all I want to do is jick-jack around and pretend I'm a "normal person."

I've been thinking a lot about my ICU vs. M/S dilemma for 4th semester and I really really really want to go the ICU route. I love it too much to even think about doing anything else, and even though the job prospects aren't as plentiful I also have to remind myself that I will never have this opportunity again and I should take it. Besides, I plan on kicking total booty during my preceptorship, so I am hopeful I'll make some connections that will help me land my dream job. After all, I throw down like nobody's business :-)

Any other news? Guess not...just finishing up some group projects and looking forward to Spring Break. Believe it or not I am actually going somewhere this time...heading to Oregon to spend 5 days on the beach. It's going to be quiet and lazy and beautiful. Just what Nurse Mo ordered.

Torn between two lovers....

For some reason that song pops into my head when I think about putting in my preferences for precepting next semester. I am torn between the ICu (which I love but am not likely to get a job in right away d/t the horrible hiring situation here) and good old fashioned M/S (which will get me a good solid basis, invaluable time management, organizational skills...and maybe a job). UGH!

It seems whenever I talk to the seasoned nurses they tell me to go the M/S route, but then I talk to others who went straight into the ICU, and those people tell me to follow my heart. Torn torn torn. I also kind of like peds, but I think the reason I've liked it so far is that I haven't had to do anything with a child that really requires their total and complete cooperation. For instance, I haven't had to put an NG tube in a child or a Foley...I certainly haven't tried an IV or even given an injection to a tiny little tot. I know how "not patient" I am, and I also know that causing pain to someone who doesn't understand why I'm doing it would be really really hard. So, even though the kiddos are cute as heck and don't have nearly the same degree of smelliness as their adult counterparts..I just don't think I can go into peds (at least not right away).

I really need to figure out what I'm going to do...I am sure I want to work in the ICU...I am 100% certain of that. I love all the gadgets and technology. I love the pathophysiology and ability to totally focus on one or two patients. I love things that are complicated and challenging, but at the same time I am absolutely scared to death. The idea of being "the nurse" for any patient (critical or not) freaks me out to no end. Right now I can take some comfort in knowing that if I can't figure something out, I just go get "the real nurse." I am reminded every time I go to clinical how NOT READY I am to take care of patients. At all.

Again...torn, torn torn. Sigh...

My butt has been kicked and handed to me in so many new and innovative ways...

I have come to the realization that nursing school administrators believe students operate in a dimension where time stands still. The amount of work that I have had to do in the past few weeks (and namely this week and the weeks to come) is mind boggling. After spending two weeks on "frontloading" which is a nice way of saying "cramming as much information down your throat as we possibly can", clinical started this week. Some folks are starting in Mental Health where they get to go sit and chat with a mentally ill person for 2 days a week (did I mention the no-prep-work part of the mental health rotation? I am soooo looking forward to that!), and other folks (like yours truly) started in Med/Surg. Among that group some lucky ducks got to start in the ICU where they got to take care of one really sick patient and do all that super cool, super OCD ICU nursey type stuff, and others (like yours truly) got to start on the Med-Surge floor. Insert heavy sigh here.

Our professors were nice and apparently realized we hadn't taken care of two patients except for one weekend last semester, so they let us ease into it by taking care of one pt on Tuesday and then picking up another one to take care of on Wednesday, so that we'd end up with 2 on Wednesday. Can I just say that the evil part of this plan was the TWO NIGHTS IN A ROW of doing my clinical prep. OMG.

For starters, I'm at a new hospital this semester and know next to nothing about the electronic charting system. So, it took me almost 4 HOURS to get all the pt info I needed to even start my prep. Don't ask my how it took that long, but I think I just spent a lot of time searching for stuff on the EMR, getting all paranoid that I was going to miss something! Oh, did I mention my first patient had 39 meds??

Clinical the first day wasn't bad, except I'm pretty sure I was charting my assessments in the wrong place all day (oops), but the RN I worked with figured it out and all is good. I did better by the end of the day, thanks to the aforementioned awesome RN I was working with.....but still...a more thorough and detailed training on how to use the EMR is definitely in order.

So, after taking care of one pretty demanding pt all day, I had to pick a second pt, then go home and write that patient up. I do not do well on 4-5 hours of sleep...I just DON'T. By the time end of day Wednesday rolled around, I felt like I'd been abducted and probed by aliens for the past three days. I logged 42 hours of work for ONE class in those three days. ONE CLASS! I have three other classes, and one more starting this week. WTF and I going to do???? Clone myself????

Anyway, that's enough bitching and moaning...now on to the good stuff....clinical was awesome! I definitely got into more of a rhythm on the second day, and was able to "almost" keep up on all of my work. I got to do my first suppository (ok, maybe "got to" isn't the proper way of putting it), hung two piggybacks (my CI had to help a lot for the first, and only a little for the second, so I'm hoping to get checked off on that completely next week). I learned I am a really slow bed-bath giver and how to say 'thank you' in Russian. I learned that some patients SLEEP WITH THEIR FREAKING EYES OPEN, and that some people just want to be heard. All in all, a good week.