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Showing posts from October, 2017

Week 11. CN = charge nurse

Here's a day in the life of a charge nurse, framed within the structure of the monomyth, or the hero’s journey (saving Murdock's The Heroine's Journey for another time).

The Ordinary World: The charge nurse, an intelligent, independent and capable professional, enjoys a quiet night’s sleep in her warm bed on a late October night, the windows cracked just so, allowing the chill of winter to creep in and crisp the air in her bedroom.

The Call to Adventure: After working the day before, she had accidentally left her pager on, and as a consequence she is abruptly woken up by it before the skies were beginning to brighten, with a request for her to come in to the hospital and help manage the floor from 7am to 7pm.

(Near) Refusal of the Call: The nurse hesitates. Having worked yesterday, she knows there are several transfers, shortage in coverage due to multiple admissions and an RN calling in sick, two one-on-one safety sitters required, therefore fewer CNAs on the floor...not a f…

Week 10. CPR = cardiopulmonary resuscitation

Scenario 1. 
An alarmingly white, well-lit airport. Ticket counter.  Your partner grimaces, collapses.  You turn to ask for help, and when you turn back, your partner has turned into a plastic mannequin lying supine on the floor.  No breathing, no pulse. You must compress the mannequin’s chest hard enough with interlaced hands to light up two green lights above the left clavicle.  Two breaths.  Thirty compressions. Please, call 9-1-1! Someone, get an AED... Analyzing: shock advised.  Charging.  CLEAR!  Shock delivered. Resume CPR. Your partner may turn back into a real person, but meanwhile, compressions and breaths keep blood pumping and oxygen circulating. Your partner’s life--interlaced in your hands.
Scenario 2.
The comfort of your home. Your cute 7-month-old mouths toys on a colorful playmat.  You turn around, and NO, this cannot be happening. Baby has been replaced with an open-mouthed, nonresponsive, rubber infant.  Luckily, you are a nurse practitioner and know exactly what t…

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 …

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 …