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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Phlebotomy

Etymology: from Greek phlebotomos “opening veins,” from phleps (genitive phlebos) “vein” + -tomia “cutting of,” from tome “a cutting.” 

I work at the hospital, and I love being a float nurse there. Part of the reason I enjoy it is the teamwork aspect. Need a room cleaned? The housekeeper is already there. Don’t have time fora  bath? Ask the PCA to help. Need a new IV start? IV team. Anything to do with a catheter? Cath team.  Instead, I focus on what I learned a lot about in nursing school: the big picture in acute care nursing. Assessments, critical changes, meds, education, and coordination.

However, I volunteer at a clinic, and I love volunteering there because it’s so completely different. Different pace, different responsibilities. I had previously volunteered in a different capacity, but yesterday I walked in for the first time as a volunteer nurse. I thought, “I work in a hospital. This will be easy.” But I got a patient’s information, walked into the room, and stammered through my interview.  I’m not used to gathering a history, except informally…I didn’t know what to ask about!

Another new skill at the clinic is, as you might have guessed, phlebotomy. K., the supervisor, mentioned that he wanted me to try a venipuncture sometime that morning and I felt… nervous. In many hospitals, nurses do their own labs and their own IVs but, as mentioned, not at ours, so sticking a needle in someone’s veins is a foreign procedure that feels personal and invasive. He had me practice a few times on a cushion and then asked me if I wanted to practice on his arm.

I wasn’t sure. Maybe I should think it over. Maybe I should study up on it.

Maybe I SHOULD practice on my husband. Maybe when he was asleep. (OK, probably a bad idea). Or could I practice on myself?

I studied K., the clinic supervisor as well as a former classmate of mine. It seemed like a bad idea to stick my boss, even at a volunteer gig, with a big steel needle. Maybe I should wait until A., a less intimidating coworker who boasted of good veins, offered her arm…

But at the same time, I wanted to be brave. “Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the LORD your God is with you wherever you go.” (Joshua 1:9).

Not to mention, “fortune favors the brave” and I wanted some luck to avoid sticking K. twice.

“I’ll try it,” I announced as confidently as possible.

Looking nervous, K. slipped into the chair. I prepared my supplies, tourniqueted his arm with the blue band, palpated, gloved, steadied, prepared my needle…

and got it on the first time!!

As I watched the dark blood spurt into the orange and black tubed vial theycall the “tiger tube,” I felt the rush of success. (Then I tried again on someone else and lost the vein after the first tube, but everyone has a few stories like that…)

***

As I walked out of the clinic after a half day, I felt like my brain was about to explode, but in a good way.  I love learning new skills and information.

Venipuncture seems to be more than another skill. The medical setting allows us to violate that most basic personal boundary – skin.  Causing them pain, tapping into the source of a person’s very life, their flowing blood. Phlebos. Cutting  (tomia) like surgeons once did to “bleed” people to health.

Now we bleed people to read the secrets of their cells. Anemia, diabetes, leukemia. So many stories are written in the blood. Answers in antigens.  We have to hurt to heal.

Tome: From Greek tomos “volume, section of a book,” originally “section, piece cut off,” from temnein “to cut,” from PIE [Primitive Indo-European] *tom-/*tem- “to cut”

Phlebotomy. A tome of blood. It all comes back to the books.