I have good news and even better news but first we have to take a detour through bad news valley.

Last Thursday, the pediatrician phoned to let us know that the thyroid portion of the PKU newborn screen had come back abnormal. She wanted us in her office that afternoon to speak with us and get additional tests completed to rule out congenital hypothyroidism. The rush was because the longer Congenital hypythyroidism goes untreated, the higher the risk of mental developmental delays and other delays.

We went in and she explained to us the tests and we also checked his weight. In a little under two weeks, he went from 12lbs 7oz all the way up to 14lbs 1oz!! The lab was next door and he had his blood drawn. Then we waited.

Three of the five tests came back with normal results by the next morning. I cried.

This past Tuesday I took him for his original weight check appointment (he gained another 8oz by the way!) and the ped had the other two results. They too were normal. The endocrinologist does not need to see him and we go back in three weeks to follow up.

We are no longer breastfeeding and he is completely on formula. After everything i went through with Charlotte and my PPD, I know my limits and pumping or troubleshooting why nursing wasn't working is beyond my scope this time around. He did nurse yesterday morning and I will continue to let him nurse as I need him to or as he wants to until my supply has ceased. Even when I'm giving him a bottle we are cuddly and have eye contact. It doesn't matter what goes into his stomach or how it gets there. All that matters is that we're thriving, happy, and healthy.

We are all of those and so much more!

Clinical Guide: Wound Care (Clinical Guide: Skin & Wound Care)
By Cathy Thomas Hess

* Publisher: Lippincott Williams & Wilkins
* Number Of Pages: 544
* Publication Date: 2004-08-01
* ISBN-10 / ASIN: 1582552940

Product Description:

Expanded and completely updated with the newest wound care products, this handbook is the only all-in-one portable guide to wound care and prevention strategies with more than 300 dressings, drugs, and other products for every type of wound. Part I provides detailed guidelines on wound care and prevention and related professional and legal issues. Part II features profiles and photographs of over 300 wound care products. Part III contains charts of over 200 additional dressings and products. Appendices include assessment tools and multiple treatment algorithms.

html | 8.2 mb

http://rapidshare.com/files/129967269/312_Cl.G.Wound.Care.2005.rar

or

http://www.megaupload.com/?d=VB7CEWWV

Things aren't always what they seem at times as our patients like to throw the proverbial knickle ball.  It just kind of hangs there, then goes in a completly different direction, baffling both you and the batter.  While there are very few knucklers left in the Majors, it seems that they come in droves in medicine.  There almost always is a strange case that grabs your attention and makes you think.  All the signs point in one way, but the reality is far different.  Such is the case here.

First, a brief  synopsis.

Deborah Peel, a 28 year-old, 6-month post-partum patient arrives at the ED complaining of weakness.  This EKG is grabbed on admit.

To give much more information (including what kind of weakness it was) would give this away.  Suffice to say, labs were normal, including cardiac enzymes.  Vitals signs were stable, blood pressure was slightly elevated though.  Patient was complaining of no chest pain or other symptoms that would be expected with the tracing shown above.  No previous history, normal delivery without complications 6 months prior.  The other clue I will lay out is that the patient went for a CT, followed by another imaging modality before arriving on my floor.

Any guesses?  C'mon, fame and glory await!  Leave your guesses in the comments.

P.S.  I have to work the next couple of days,but I'll be checking to see and will confirm or deny guesses,also in the comments.  I will also say that my firend who looked at this said, "Did you call the doc? How about an EKG when they got to the floor?"  Both of which were answered in the negative.  Is your brain in gear?

Today's nursing repretoire consisted of all things involving IVs. We learned about the tubing, compatability, piggybacks, administering iv drugs, bollus injections, gravity flow, and setting up the pumps. Then, we got to play with syringes and doing saline flushes on these creepy fake rubbery arms. A few of us got distracted, and had fun squirting each other with the saline syringes instead. We had to be in the upfront sunroom, that's why so many people are wearing sunglasses. Then, there's the shot of one of our teachers Candice Ginsberg says we're so bright she's gotta wear shades.

[gallery]

everything had to stop for me because i have to take care of my sick brother. he's in the hospital now and is being observed because the doctors can't rule out anything yet. anyway, i have been spending a lot of my time in the hospital and i got tired of Dr. House. I had to date Chuck and Sarah Walker (of the tv series Chuck) and Clark Kent and Lana Lang (Smallville) to get me out of boredom.

anyway, going back to the hospital brings back that sort of spark whenever i like something. as you all know i'm a nurse. when we brought my brother to the ER, i can feel the excitement of having to be there. i like ER duties. i like giving care to those who needed it instantly. blood, needles, wounds don't scare me easily now. i like the idea that i get to ambubag a patient while trying to figure out what to do next. the adrenaline rush... i can't explain it really... having to apply pressure to a wound... having to insert an IV... to inject medicines... it's like i'm having my own world when i'm in the emergency room.

what's more exciting is having to fetch a patient or bring a patient by ambulance. it feels like i'm invincible. now i remember my experience when we were trying to fetch a very toxic patient from another hospital and they didn't endorse that we need to bring a suction machine because the patient's secretion had to be suctioned. the doctor who came with us decided to bring the patient even without it. you know what happened? the ambulance stopped in the middle of the road. something was wrong with it and we were stuck with a patient who was really in danger in drowning in her own secretions! and do you know what's worse? it was raining! even the orderly didn't understand how i was able to get out of the ambulance holding 2 IVs while ambubaging the patient. that was really an experience!

there's one thing i hate about hospital duties though. there are really persons who are very hard to get along with. it's like their favorite past time is to torture other people by saying things that are not supposed to be said. nurses and doctors should be empathic but sometimes they(we) are the one who speaks out of the line. that's why you get to see patient's loved ones making a scene because nurses and doctors are not therapeutic in dealing with people.

of course, there is always gossips anywhere and that does not exclude hospitals. and yes, hospitals have its own version of scandals too. it's between a male doctor and a female nurse or an intern and with a nurse or a doctor... it's all messed up.

despite of those things, i really like taking care of sick people and even sick, arrogant ones. the sick patients are not really the hardest people to deal with. it's their loved ones. but then it goes with package. they are affected too and sometimes they don't know how to deal with the situation. patience and understanding have to be stretched to avoid confrontations.

so there. i've blab again without knowing as to where this topic is going. i have to go now to catch up with the attending physician because i was questionning the intern's prescription. i'm no doctor but i do understand some stuff too.

have a great day everyone while i get myself stuck with Clark Kent and Lana Lang to finish the 7 seasons of smallville. yep, dibidi marathon....

I am an active member of the forum since May 2006. I really love this forum and it is quite addicting. It was founded on the year of 1998. Currently, it is the #1 nursing community for nurses at the same time the largest active online nursing forum. Allnurses has given me direction on my nursing education and now my nursing career. The people there relentlessly without a doubt answers your every query. They welcome everyone and has been very helpful from the start. It helps in motivating one in your chosen field in nursing. There are significant information that can be learned every day which only takes some few minutes to read.

The forum is a complete package, it has everything from jokes, scrubs, NCLEX, nursing specialty to nursing experiences. There are regional sub forums that specifically caters people according to their location. Like for every state in US, Philippines, Canada, Australia, New Zealand and UK. Everything that you can think of is all there. Although, you have to read first the previous posts since most of the queries has been discussed already. Remember also to follow the posting guidelines.

I would like to give thanks for the moderators in every sub forums there. Special shout out to Brian Short, RN, the founder of Allnurses.com. Mostly, all the moderators are working as RNs while investing their valuable time and effort in the forum during their spare time. If you are student nurse, RN, LPN/LVN, whether male or female, you might want to drop by the forum and let your voice be heard.

PS. I hope I could get a membership upgrade, anyone? I would be very thankful. =P

As a Nursing Student I am dissapointed at the RCN's decision to forward a plan to stop us voting for decisions made at congress. I mean why should we be forced into a listening and watching role instead of making our mark on the nursing community and decisions made to improve healthcare for patients. this decision is cutting back around 34,000 of us Nursing students right across the country I feel we should have more respect by the RCN because if you look at we are the future of the NHS. If the RCN want to influence the nursing community at large and make changes that can be implimented in the near future and also to meet government targets then they only sensible way they can do this is through giving us a chance to give our views and get our support of nursing strategies and ways to improve care for service users right across the United Kingdom. Without the support of this generation of nurses the RCN can be looking at missing future targets and trusts will begin to fail causing more problems cutting our voices at congress is not going to give us the motivation to strive to give the best healthcare we can to service users. On the Nursing Times website in the article talking about this subject, Ben Mott a student member of the Council stated;

'When you take votes away from the student group at congress you start to demoralise the Association of Nursing Students. I can't believe that such an oversight is allowed to get through to the final version of the report,'

This is exactly how I feel as well and I am sure it would be safe to say other Nursing Students feel the same way as well. Ben went onto say that this would make ASN members not want to become a part of the RCN which could cause problems. I have to admit I would have doubts about joining the RCN after this because what is the point if we are forced to listen but not voice our views. I seriously suggest that the RCN rethinks this whole concept as it could damage the nursing community.

 So recently we had an issue with a family member (not my relation, wink-wink) who frequents our house the issue deep down is me taking things too personally, BUT this person wouldn't quit.  As I went about my daily parenting activities, the person we will call Sally  would offer comments on each and every thing I did I was inundated with the following comments about my 2.5 mo/old:

• How do you know the baby is eating enough if you are nursing?
• Have you thought of giving the baby formula, or sugar water?
• Babies just cry, you are spoiling the baby
• Attachment parenting sounds like a trend to me
• Put the baby down already
• I started my kids on food at 6 weeks, you should too
• Why aren't you putting the baby in the crib
• that carrier is silly, you should let the baby just lay down and cry, it is good for them
• Co-sleepers will spoil the baby
• Organic food is just a ploy to get you to spend more, look at my family, we are fine.

Just so you know I don't preach about the above mentioned stuff, they ask me questions and I answer them simply.  This visit they were flipping through my favorite baby book.

I am listening to all this and grinding my teeth, I actually didn't respond to any of these comments.  I am usually a Pollyanna about things, I don't always achieve it, but I do believe in the Power of Positive Thinking. I have witnessed the effects of having a negative mindset and a positive one, and the latter is much more appealing.  During this hailstorm of negative comments the baby was crying, a lot which only made the comments more annoying.  

Then Sally's daughter said, You know what, crack heads have babies and they survive.  I looked up at her and just stared at her in disbelief.  I wanted to yell: Well sorry we have higher standards than crack-heads thank you very much!  What the heck kind of comment is that?  The staring made her really uncomfortable

I don't do this, even when someone is doing something that goes against my beliefs I shut my mouth.  So I am still steaming about it a week later. 

My confidence wasn't really shaken when this happened, as much as other times like when I was scolded in public for not covering the baby's hands with mittens to avoid people passing germs, since people love touching baby hands, when that happened I burst into tears and felt like the worst Momma out there, I have pangs of Momma guilt about a lot of things....

So what do you think, how should I have handled this?  What would you do?  Have you dealt with similar stuff?

Tuesday, July 15, 2008

One year ago from today, I was full of nerves, knowing that I was starting my first nursing job the very next day.  I had only graduated in May, hadn't even passed my boards yet, and wasn't even completely sure that I liked nursing based on just my clinical experience.  I wasn't sure I would ever really feel comfortable being a nurse.  I was anxious about meeting my work colleagues, and insecure about learning new policies and procedures.  I had worked at my last job for almost 10 years!  And now I had to learn all over again...

But now, here it is, one year later, and time seems, as usual, to have flown by.  I don't feel so nervous every day when I go into work because I have a year of experience under my belt and I know that no matter what the situation at work, there is ALWAYS someone else that I can ask for advice.  I work with WONDERFUL colleagues (in fact, if not for them, the job wouldn't be that great).  I love the feeling of really being able to help patients in their time of need, but often I still feel frustrated by lack of time and feeling rushed all the time.  I'm not sure if I would have chosen this career if I knew everything that it involved, yet I think that's how most people feel about their work.

We'll see how this next year goes.  I'm starting school this fall, so I'll have one more thing on my plate.  Hopefully it will help me to become a better nurse as I'm learning about being a nurse practitioner.  If anything, I will always still have the perspective of the floor nurse, which I think is essential NOT to lose sight of.

I'll be interested to know what I think of nursing one year from now.  Let the next year commence!

The IHI held another conference call recently on "How Do I Communicate With My Team Effectively?" This time I dialed in. It was pretty cool. The call was a little heavy on theory (when I'm stuck in a communication problem, I'm not gonna think, "oh yeah: S-BAR!"), but it had a lot of really good tips. Get the audio or a transcript here.

They've got forums and stuff too. I think they've got a good thing going here and hope they get support to keep going; they're moving in a good direction for helping students get a leg up with the trickier personal and interpersonal aspects of becoming a health care professional. Check it out.