Spring Break? Are you out there?

Oh my goodness! I'm tired. This is intense. I'm realizing that it's not actually the intensity of school that's killing me, but the need for endurance. I've always been a sprinter, but I thought that was only for running. Apparently not. Nursing students are just working at a high level of activity...all the time! It kind of goes like this: 

ME: ok. I turned in my research paper, so now a little break. 

school's response: NO, YOU FOOL! There's a midterm on Monday!

ME: oh, so then Monday afternoon?

response: Have you forgotten you have pt teaching at post-conference on Tuesday!? and how                       about learning your pt's meds for this week? You think you'll get that done by                                 watching The Office?

ME: oh, right. I forgot those things. Ok, then, for sure after Wednesday I'll be golden.

response: JUST KIDDING! What about that other midterm next week? Then it's practically                         finals, so you might as well just forget about it, sucker! You're DESTINED for fatigue!

ME: whimper...

      

Hodge-podge

Since my epigastric pain pt was D/C'd on. So, I got someone /c MRSA (methicillin resistant staphylococcus aureus). Med Dx: aspiration pneumonia. Also presenting /c hypotension & tachycardia probably secondary to dehydration. Also /c Hx of non-Hodgkins lymphoma, and here's the string of events: non-Hodgkins lymphoma --> Tx (treatment) --> esophageal striction (from the treatment) --> aspirating food, etc --> aspiration pneumonia --> Tx /c balloon esophageal & vancomycin x2 weeks via PICC line.  I don't really remember anything about this pt b/c I didn't do my careplan on this one, and I was helping the nurse /c his other pts too. But this one was definitely Contact Precautions.

However, one I do remember a bit better was the man who came in /c aspiration pneumonia d/t esophogeal stricture as result of radiation for non-Hodgkins lymphoma. He also had a PE (Pulmonary Embolism - a blood clot in the leg, usually, that dislodges and goes to your lungs. Not good.) He also happened to be an IV drug user, so he had lots of advice for the nurse as how to best administer his IV meds.

"I'm not diggin' that idea"

Week 2: 70 yo female

Med Dx: chest pain

PMHx: CHF (chronic heart failure), CKD (chronic kidney disease), HTN, DM Type II,  Hyperlipidemia, LBBB, Hyponatremia, chronic epigastric abd pain, anemia, atherosclerosis, allergic rhinitis

Isolation: standard precautions

This lady was admitted for chest pain, but as you can see, she has a host of other problems as well. The two main problems for her this week were her epigastric pain and CKD. Though she came in /c chest pain, that must have resolved pretty quickly b/c every time I did a pain assessment she said her only pain was the abd pain. (Btw, chronic epigastric abd pain is like a burning feeling in your gut d/t over production of acid. Protonix is a good med for reducing this excess acid.) Here's my SOAPE note for her abd pain:

S - pt c/o burning abd pain x1 week. pt states: "it burns, especially after I eat".

O - pt frequently mentions abd pain. pt no grimacing or showing other signs of discomfort.

A - abd soft, not distended. BT audible.

P - admin Protonix (40mg - schedule 0900 med). re-assess pain in 30-60mins /p admin.

E - Gave Protonix (40mg) @ 1000. 1045: following med admin & breakfast, pt reports burning pain decreased. 1230: reassess pt's pain, and pt reports not pain.

Problem Solved. :) The Protonix seemed to help and she really wanted to go home, but really, she also needed kidney dialysis (d/t the CKD). She really wasn't diggin' this idea, although she already has the fistula for it. (Fistula: this one was in her L arm at the elbow, near the area where you would have blood drawn. To make it, the surgeon connects an artery to a vein. The blood moves very turbulently through it, called "bruit", pronounced broo-ee, which you can feel, and hear (with the stethoscope). Anyhow, she "won" this battle and went home saying she would think more about dialysis.

                                         

There's a Rumbly in My Tumbly

week 1: 77 yo male. 

Med Dx: gastroenteritis, tachycardia, dehydration

Isolation: contact precautions (gown & gloves) d/t possible C. diff infection

This guy came to the ER from a SNF (skilled nursing facility. i.e. nursing home) /c S/S of the above. The tachycardia is why he's on Tele. Apparently several other residents at his SNF also presented at ER with same S/S, and so, he was tested for C. diff infection. His dehydration is probably related to his gastroenteritis (diarrhea, which gets rid of fluids fast), and OA's tend to drink less water anyway. It was also noted that the gastroenteritis was the suspected cause of the tachycardia (SVT-supraventricular tachycardia), which was resolved after 12mg adenosine & amiodarone gtt.