Skip to main content

Posts

Week 9. HF = heart failure

Starling's Law: the healthy heart can handle precisely the volume of blood brought to it by veins. The greater the volume and fiber length, the more Romeo-and-Juliet-like actin and myosin behave, and the heart pulses as hard and fast as necessary to pump all of one's blood through the body once in one minute.

In the failing heart, Starling's law breaks down. In 40 minutes, death from pulmonary congestion can occur. (Some online instructor, long ago, thought it funny to include a picture of a tombstone in green grass on this particular PowerPoint slide. Incidentally, the Chinese call marriage the dirt grave of love.)

Do people still believe in love? Surely, some do, because there's such a thing as broken heart syndrome. Sadness -> stress hormones -> vascular constriction -> chest pain, shortness of breath, hypotension, arrhythmia, possible heart failure. It is literally possible to feel one's heart break, over and over, years apart, especially since humans …
Recent posts

Week 8. PRN = pro re nata, as needed

Pain, like taste and attraction/connection between people, is highly subjective and individualized. There's no one-size-fits-all pain pill or absolute guarantee of relief. Different people's experiences of the same procedure vary widely. Vicodin may have been candy for House, MD, but might do little for others.


While living pain-free, one does not ponder pain intensity scales, Wong-Baker faces or WHO analgesic ladders, but if one is in pain on an hourly, daily, seasonal basis, those pain measures and meds are like saying the right thing and going to the right houses/neighborhood as a trick-or-treater and getting the good candy.

But sometimes one's family doesn't want one to get the good candy, those big candy bars or entire bags of Skittles and M&Ms. Even if one is end-stage-something-rather, one's family somehow isn't convinced one won't end up on the streets trying to score more candy. So non-opioid analgesics it is. And pain, coming in waves, dull th…

Week 7. D/C = discontinue or discharge

Many things can be discontinued: a specific medication, intervention, intravenous infusion no longer needed or working as it should, nurse-patient relationship, any relationship. Though of course something discontinued can always be started again, if needed, perhaps elsewhere. If there are no good veins left on upper extremities, the nurse starts digging into veins in a soft calf, even if the patient protests softly, "Ai, ai, ai."
An IV can be d/c, but only living, breathing people can be D/C (discharged): to go home, to a skilled nursing facility, to a specialized facility, or in some cases, back into the streets. Some people go home alone and perform self care, self medication, self everything. Some require the care of family. Some go to fancy nursing homes much like four star hotels. Some need around-the-clock monitoring and medical attention. Some have no idea what year or date or city or realm they exist in although everything seems to always smell faintly of urine and …

Week 6. EtOh = Alcohol

In honor of the weekend (and no invisible planet hitting us today), here's a really-quite-serious, "How drunk are you?" quiz based on how pickled your brain feels (loosely adapted from Table 38-1 in Lehne's Pharmacology for Nursing Care, 9th ed.)


1. Increased confidence? Euphoria, decreased inhibitions? Congratulations, the alcohol has reached your frontal lobe. Blood alcohol approximately 0.05%.

2. Loquacious? Judgement altered? Your frontal lobe continues to be affected, and you are now at or past the legal limit of intoxication, 0.08%.

3. Tremors? Involuntary body movements? Reduced attention? Your parietal lobe's been breached. 0.15%.

4. Reduced motor skills? Slurred speech? Parietal lobe conquered at 0.2%.

5. Altered perception? Double vision? The occipital lobe's getting pickled, 0.25%.

6. Altered equilibrium? There goes your cerebellum. 0.3%.

7. Feeling apathetic? Inert? In a stupor? Really shouldn't continue, because you're down to the diencep…

Week 5. Drsg = dressing

Wounds must heal from the inside out, the ruptured skin one's largest organ.

Wound care: to change dressings, carefully loosen the tape around margins. Moisten if dressings stick during removal, then assess and measure the damage, including size, color of tissue present, amount and type of exudate and color. There may be tunnels, undermining, necrosis, awe-inspiring and terrifying geological formations of the flesh, craters and caverns, deep vale all the way to white bone. Irrigate with 0.9% saline, or tears, if you like.

Actually, no crying into open wounds, because maintaining a sterile field is imperative for healing. Never turn your back, either. Pack gauze, cover, tape, box method.

And if the gruesome, bone-in-the-middle wound doesn't kill one, one's GPS might try to kill her by repeatedly sending her back to the same spot, barking, "turn left," (into oncoming traffic), over and over again. She might survive, but the P. sennae butterflies liquified against h…

Week 4. IM = intramuscular

So many things are skin deep. Beauty, blemishes, piercings, skin itself. An intradermal injection done correctly: bleb on half a hot dog, tiny yellow bubble on the hefty cake of human flesh or adorable meat cupcake. If you were vaccinated for TB as a child, no more skin tests for life. (It's radiation from chest x-rays for you every two years instead.)


Almost always, the vaccination is worth the risk. Protect your child, protect the immunocompromised, achieve herd immunity.

But we can't vaccinate for everything--not the unexpected, the accidental. Sometimes an old ampule explodes in one's hands, all glass shards and beads of blood, a symbol of something specific in one's life shattering into a hundred pieces, embedding tiny crystals in the skin, the clenched towel insufficient to stop the bleed. Sometimes the hurt is too deep, subcutaneous, intramuscular, all the way to the heart. (The heart's mostly muscle, too.)

But it's no use worrying every time an ambulanc…

Week 3. Inj = injection

"Take then thy bond, take thou thy pound of flesh." (Shakespeare, Merchant of Venice 4.1.13) The star of this week: Shylock's pound of flesh, courtesy of Limbs & Things. Half a log cake: rubber epidermal frosting, spongy subcutaneous cake, red muscular filling. Best thing ever because all those injections would have gone into our skin, our flesh. (This time next semester we'll be human pin cushions.) Also great for petting in lap like Dr. Evil's cat.  Pound cat--no claws, slightly sticky to the gloved touch.
Sterile gloves must be opened up and put on in very specific manner. Hands do not go below the waist; keep every finger in sight at all times. Sterile supplies like Foley catheters must be unwrapped, laid out and prepared just so. Lubricate the tip before contaminating one hand holding apart patient's bits. Never cross the sterile field, lean, or talk over it. 1 inch borders all around. 
Do not inflate a balloon in someone's urethra, or what'…