Month: March 2013

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From A(cetaminophen) to Z(ofran): An Alphabet of Nurses

You’re in the hospital. Your nurse is trying to make you better. What is s/he bringing you?

Warning: Blunt nursiness to follow. May be too much for those of a delicate temperament.

Acetaminophen: Come on, y’all, you know this one. Tylenol! Takes the edge off pain (except pill-seekers) AND fever. Double whammy.

Beta-blocker: Okay, okay. It’s not technically one medicine. But if it ends in -ol, it’s probably a beta blocker. Like atenolol, propranolol, etc etc. Great for lowering a high blood pressure.

Calcium: “Come on, I take this at home for my bones!” Not so fast, snarky reader. Not only is calcium great for bones, Tums are great for your tummy.

Digoxin: This was one of the first meds we learned about. It helps to slow the heart and prevent arrhythmias. Cool fact: comes from the foxglove plant!

Enalapril: This is an ACE inhibitor, another blood pressure medication. Can cause a nasty cough.

Flomax (finasteride): Look this one up, y’all. But a lot people get it.

Ginger ale: A lot of people swear by it for nausea…

Haldol: OK, I’ve never given this, but in a nod to psych nurses, this is an important one for chillin’ people out.

Ice: Great for pain and fevers. Sometimes old remedies are the best.

Juice: Great for clear liquid diets, bad for blood sugars. Especially popular – prune, effective for the bowels.

K-phos: On dialysis? Take your K-phos with your food!

Lasix: Gets the fluid off by making you go to the bathroom. A lot. Great for heart failure, bad for potassium.

Milk of mag: A fantastic bowel med, especially when mixed with prune juice or coffee in the delicacy known as a “Brown Cow”

Normal saline: Also .9 NaCl!! Almost everyone gets a bag of this. No nutrients, just straight isotonic fluid replacement.

Oxycodone: The gold standard of pain pills. Some permutation of 5-15 q 2-4 hours should get you through (we’ll titrate up slowly because we don’t want you unconscious!)

Potassium: Nasty big horse pills. Or nasty orange powder. Or nasty “K-rider” that will hurt as it goes in. You take your pick.

Quease-Ease: Great for nausea for some, useless give-away for others. Smells minty. My teacher said you could get the same results with an alcohol wipes, but alcohol wipes don’t look nearly as cool as the submarine-like Quease-Ease tube. And the scent lingers for months!

Respect: I snuck this in here instead of Rifampin, because nurses have (or should have) a lot of respect for their patients. Mutual respect is essential to the healing relationship.

Sulfas: Great for infections. Bad for allergies.

Tiotropium: You got COPD? You’ll get this inhaler (AKA Spiriva) 

Ultram: Tramadol, the non-narcotic narcotic

Vancomycin: You got an infection, we’ll give you a PICC and pump you full of this. But slowly. Cuz it bubbles. And it will turn you red. And if it gets into your tissues… it’s bad.

Water: Ice water, and lots of it.  

Xanax: You are getting sleepy… very… sleepy…

Yaz: OK, I don’t give this much either, but the few young women who I treat usually bring their own from home.

Zofran: Great for nausea, oral or IV.

There you have it! A nursing alphabet!!

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Maundy Thursday

I went to my first Maundy Thursday service (that I remember) this year. I even played handbells on a beautiful piece. The  service was lovely and somber and moving and dark, as any service commemorating the night before Jesus died should be. After all the lovely music, after communion, after a message about foot-washing and being a servant, the pastors stripped the altar… black cloth of mourning was draped over a cross and over the tables. Then we left quietly, without the usual greeting and gab that comes with the end of service. I felt as though we were still “suspended,” waiting for a resolution.

Later on I got to thinking – what if I was to commemorate Maundy Thursday by reenacting it?

My buddies and I would follow a random stranger to a private room, where they would all argue. I would wash their feet. Then my best friend would leave the party to betray me. Then I would spend all night praying in a garden while my friends fell asleep instead of keeping me company. Then I would get arrested and go to jail…

***

Our pastor told us that “Maundy” comes from the Latin for “command” (In Spanish, “mandar”) as in John 13:34, “A new command I give you: Love one another. As I have loved you, so you must love one another.”

Whether it’s footwashing…

or forgiving someone who betrays you…

or going the extra mile for someone you dislike…

Whatever it takes, we need to love one another. That’s his command to us.

That’s the best way to commemorate today.

 

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Losing my Brain

I lost my brain tonight.

You can’t blame me. It was a long night. I floated to 2 different floors, had 5 patients over the course of the night, and pharmacy wasn’t sending me my patients stuff . I was just starting to get a handle on things when I lost my brain.

No, no, not my mind (though that was fuzzy too). My brain sheet. Most nurses have a “brain” with reminders of what to do when. Mine had everything with everything marked down – what meds, what vital signs, blood sugars, things to follow up on, when to empty drains…

And I lost it!

Thankfully the charge nurse gave me lunch AND found my brain sheet on the floor of my patients room. I felt like a new woman after my blood sugar climbed back into the normal range and I had my scribbled to-do list in front of me.

So that just proves… Something 🙂

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Thoughts on the End of A Shift

I write this as I walk through the halls after a long evening shift. Fortunately they are empty.I was busy all night, too busy. Nights like this I wonder: was it me? Or was it the assignment?

I know this shift will haunt me. Fortunately my patients were all fine at the end, but… I don’t know what I don’t know!

There’s a lot of guilt that comes with nursing. We want to be everywhere and do everything for everyone and we can’t. We have to delegate. And I will have to forgive myself and let it go.

All right I’m at my car. Breathe in,breathe out. Thank you God I do love my job. And my patients. Bless them all. Good night.

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The Danger of Settlers of Catan

I love games. Card games, board games, dominoes – I enjoy the friendly give and take of games, the chance to focus on an activity together and use my problem solving abilities.

But there is one game that I dislike, and that is the ubiquitous game Settlers of Catan which has a board, cards, and dice. It’s the quintessential game night game – takes a long time, accommodates up to four players, makes people feel “in the know” and cultish while at the same time being very familiar and straight forward.

If you’ve never played, it’s a resource production and utilization game. Every time a particular number is rolled, a certain good is produced. You can use those goods to build certain things and you get points for building them.

How can I not like it?

Well, I don’t. Fine… I’ll play it with you if you really want me to. But here’s why it’s NOT my favorite game.

1) It makes many people mad. Or at the least irritable and competitive. Even good friends. Even when you know it’s “just a game.” Even when the people playing are nice, ordinary, sweet, gentle people every other time you see them.  And it makes people upset because…

2) It’s a game that has a fair amount of tearing down what other people are building. Many of the cards give you the opportunity to take cards from other players, even though they may have been accumulating that particular card for a long time. In addition, every time someone rolls a 7  (the most common roll), they can relocate a piece on the gameboard that then takes away other player’s productivity.

3) It’s a long game that allows people to simmer in their anger and resentment. Instead of – “oh, rats, lost that hand, let’s play another” it goes on and on. “I’m still losing because X took this card and I couldn’t build that important thing and Y built a road where I needed to go and and and.”

I like a friendly bit of competition. I am not saying that games shouldn’t be competitive. Somebody usually has to win. But I don’t enjoy games make people short with each other and snippy and chilly and cause a negative attitude that hangs over the rest of the game.

Maybe Settlers is perfect for some groups. But not for me. I’d much rather play Pandemic, Ticket to Ride, Sequence, Mexican Train, bridge… there are so many good ones! In my view, life is too short to play Settlers.

 

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Pom Pom Sunday

Today is the Sunday before Easter. Palm Sunday, or Pom Pom Sunday as some in our church call it, is the beginning of Easter Week. 
 
If Easter Week were a psych patient, s/he would be a rapid cycler. Palm Sunday: yay he king is coming! Maundy Thursday: A big dinner and an arrest. Good Friday: tears and despair and earthquakes.  Sunday: yay Jesus is risen! There is a lot of emotion and drama in this brief week.
 
I really enjoyed our service this morning, even though the music pastor had travel difficulties and was unable to make it to a Sunday with a great deal of music. Everyone rose to the occasion – the guest organist, the assistant director, the choir member who had played the piano part once before but did great. We in the bell choir processed in, ringing our bells, and everyone else did a parade with the palm branches.
 
I enjoyed the interruption in the routine – memorizing our music! Processing through the aisles! Waving palm branches! Palm Sunday is a rebellious holiday. 
 
It was rebellious then, too. A king who is actually a carpenter, riding on an unbroken donkey rather than a white horse. A shepherd king leading his people with a  staff, not a sword. 
Riding in like a conqueror when he was actually intending to submit, to die for his people.  
 
And the people celebrating him weren’t officials or soldiers or music directors. No one was throwing confetti. No. Instead, common people were laying their coats in the streets. They were celebrating their king.
 
Their king and ours.