You are currently browsing the monthly archive for February 2008.
I found a beautiful, shiny silver hair today, and I was happy.
No salt and pepper for this girl. Oh, no.
1. I’m looking forward to being back on my floor next week (after a very long week of residency classes).
2. I don’t handle people who live ungrateful lives very well.
3. Chocolate is something I could eat every day.
4. Warmth and sunlight are good for the soul.
5. D.C., here I come! 13 days….
6. I generally dislike tattoo(s).
7. And as for the weekend, tonight I’m looking forward to knitting along to The Wire, tomorrow my plans include laundry and going out with a friend, and Sunday I want to finally finish those damn sleeves! (It took me over two months just to start them.)
Click here to fill in your own blanks…
Sinus Rhythm (SR)
Normal heart rate (60 – 100), normal rhythm (P wave before every QRS complex; all P waves look alike; all QRS complexes look alike; normal P-R, QRS, and QT intervals)
Sinus Tachycardia (ST)
Fast heart rate (100 – 150), normal rhythm
Seen normally with excitement or exercise
Supravenricular Tachycardia (SVT)
Faster heart rate (150 – 280), abnormal rhythm
When studying the strip, P waves may or may not be present. The rate is so high that the P waves are often hidden in the T waves. The QRS complexes are narrow, unlike the wide ugly QRS complexes found in ventricular tachycardia (a much worse rhythm).
Assess the patient to see if he/she is stable or unstable (symptomatic). Symptoms include: weakness, fatigue, shortness of breath, anxiety, and hypotension (blood pressure is down because of a decreased cardiac output – the chambers of the heart don’t have time to fill as usual). Palpitations are not a symptom because you can expect them with any kind of tachycardia.
SVT Management:
Make sure the patient is on oxygen, has IV access, and is hooked up to a monitor. Keep a crash cart nearby. Try valsalva maneuvers/vagal stimulation to lower the heart rate. (Tell the patient to bear down as if he/she needs to poop.) With the stable patient you’ll be treating the SVT first with adenosine. (With an unstable patient skip the adenosine and go straight to cardioversion unless the doctor says otherwise.)
Adenosine has a half-life of only 4-8 seconds, so you need to give it quickly in order for it to reach the heart and be effective. You’ll need an IV in the AC or higher (a central line is preferred). Have the drug and a bolus of 10-20 ccs of saline ready to give right after each other (you stick both needles into the port at the same time so that you can shoot the bolus in right after the drug). With adenosine there should be a brief period of asystole (very important to have the crash cart close by) before the heart resumes a normal rhythm. There are three dosages to follow of 6 mg, 12 mg, and 12 mg. If the drug doesn’t work by the third round, you move onto cardioversion.
Cardioversion is similar to defibrillating (shocking) the patient. The difference is that the joules delivered are lower (starting at 30 vs 200/360) and are synchronized with the patient’s own rhythm. When cardioverting a person, don’t forget to be a nice nurse and give them some Versed, Valium, Morphine, etc. beforehand. It’s not a fun experience.
Additional treatment may also include ablation therapy, a procedure done in cath lab. The small group of cells that are triggering the SVT are located and killed.
** New nurse’s understanding of SVT management after two days of an arrhythmia recognition class. Feel free to correct any misunderstandings.
I’m going to spend a long weekend in D.C. next month to catch up with my best friends (who live in Florida and Virginia). I’ve never been, and I have no idea what I want to do while I’m there.
I’m am certain about one thing, though. I want to take at least one incredible photograph. Maybe two.
Every other school day I spent all of chemistry watching the clock. I would be the first to leave when the bell rang, in a hurry to see him again.
An unexpected schedule change during my senior year left a void to fill, and my counselor suggested that I spend it as one of her aides. Jared was asked to show me the routine that first day; from then on we did everything together.
We were walking slowly through the hall one afternoon when a door behind me slammed open, just missing me, and hit the wall with a loud crack. He spun around. “Are you okay?” An angry kid walked through that open door, and Jared charged over to him. He towered over the sophomore as he began a blistering verbal attack.
My initial shock melted into a warm pride as I watched my tall, blonde crush defend me.
photo by Miss Mags
*Feel free to share your own sketch through a comment. There are no themes. Pick any emotionally charged moment of your life, and write.
My juror summons is for the same week that I had plans to visit my friends in D.C. I had wanted to buy my (nonrefundable/slightly cheaper) flight tickets already, but now I need to wait until I hear if I can delay my duty. I know that it’s likely I won’t be picked to serve, but I can’t stand the possibility of losing that money.
Update: Postponed until April 14th!
PBDS stands for Performance Based Development System. It is designed to assess a nurse in three areas: critical thinking abilities, interpersonal communication skills, and technical skills. I took it today, and sometime in the near future I’m supposed to sit down with someone to go over my results. From there an education plan will be formulated to meet the areas that I lack knowledge.
The entire test was done on computer, mostly through video vignettes and photos. I simply typed my answers in the appropriate columns.
The video vignettes depicted common clinical situations and complications. I was to assess the situation, lab results, and vitals to come up with the patient problem, interventions, anticipated orders, and rationales. The situations I remember having to cover today are: CVA, thrombocytopenia, acute renal failure, intracranial bleed, myocardial infarction, pulmonary emobolism, digoxin toxicity, bladder retention, ketoacidosis, pain control, and ileus**.
There was a section for troubleshooting IV problems. I would see a picture of an infiltrated IV site; extravasated IV site, an IV cathether that came loose; leaky bag; cracked bottle; etc and then write what I would do to correct the problem.
One section wanted me to prioritize situations by Must Do (take care of within an hour), Should Do (take care of by end of shift), or Could Do (can wait until next shift or later time). If I labeled a situation as Must Do, then I needed to write out some interventions as well. Some examples of situations: visitor cardiac arrests in semi-private room, annual evaluation scheduled today, doctor says you need to accompany patient to procedure that could last up to 90 minutes, a no-code expires at the beginning of your shift and the family is in the room, staff meeting in one hour, a nursing student is working with you and he/she needs to be oriented to the daily activities schedule, etc.
The most ridiculous was the Win/Lose, Lose/Lose, Win/Win section. I would listen to a conversation (nurse/patient, nurse/family, nurse/nurse, and nurse/doctor) and assess the situation. I had to write what the actual outcome of the situation was, an alternative or desired outcome, and what the nurse could have said or done differently. Seriously, the hospital has been trying to get rid of this section for two years now. I timed out and didn’t get to finish answering the last situation, but it doesn’t really matter.
** I realized later, after I had submitted my responses, that I had labeled the patient problem as parastalsis. Yes, I said the patient’s problem was the “rhythmic contraction of smooth muscles to propel contents through the digestive tract” (thank you, Wikipedia). Doh! I was thinking paralyzed bowel and ileus and somehow …. Whatever.
1. Trying new foods is the best thing about traveling.
2. I love a good cup of hot chocolate when I’m cold.
3. I often use Post-it notes.
4. I’m reading my juror summons right now; I dread it.
5. Celebrity gossip is something I dislike talking about.
6. When I visited Colombia, I most looked forward to seeing family.
7. As for the weekend, tonight I’m looking forward to knittin’ and Netflixin’, tomorrow my plans include bathing my dogs, giving them their shots, and dinner with a friend, and Sunday I want to write for a contest and plan Monday’s activities! (I love my long weekend!)
Click here to fill in your own blanks…
I have a sweater that has been lacking sleeves for over two months and an afghan that hasn’t been touched in weeks. I do intend to finish them as I have two future knitting projects in mind that I won’t start until I finish the u-necked sweater. (The blanket can wait as it will be part of a gift for a wedding that won’t take place until next year.)
I find myself clipping knits from advertisements and magazines in the hopes of duplicating the item. The two I want to tackle next are:
Alloy Trapeze Cardigan and Adam Shawl-Collar Sweater.
I’m not much of a designer, but I’ve found some patterns in magazines that I can easily modify. I’m deciding between a few cable patterns for a red trapeze cardigan, and I’m thinking of using Vogue’s flirtation cable for the sweater. I already have some beautiful copper buttons that I want to use, but I haven’t decided on the sweater color yet – probably a blue or green.
I guess I could say that, even when I’m not knitting, I’m thinking about knitting.
photo by pallid7
It was pizza day so the lunch line was extra long. I stood toward the end watching the two girls. My friends and I were nice and let them sit at our table, but today everyone was gone on some group trip. Crystal pointed at something with her fat finger and started laughing so loud that the kids behind them were turning around. Theresa looked confused as usual. Something wasn’t right with her; I’d heard whispers of “learning challenged.” She dressed like a middle-aged woman, probably her mother. She asked me last week if I’d hit “poo-burty” yet.
I got out of line and walked past the square table with empty orange chairs. I ignored Crystal’s chubby wave as I made my way to the vending machines. Stuffing the Doritos and Coke into my bag, I walked out of the cafeteria to the girls’ bathroom by the gym. I wasn’t as nice as I had thought.
I fiddled at the sink until the bathroom was empty. When the last girl left, I headed to the farthest stall to eat my lunch. I couldn’t decide which would be more embarrassing: sitting alone with Crystal and Theresa, or getting caught eating in the bathroom.
I had swallowed the last of the Coke to wash away the stale, cheesy taste when the door burst open. A group of girls walked in laughing, and I could soon hear the rasps of a lighter.
I quietly laid the trash behind the toilet, flushed, and walked out of the stall. The girls said nothing as I washed my hands. Then their leader leaned forward. “You’re not going to narc, are you?”
The bell rang, and I stared back just a moment before pushing through the haze.
*** Feel free to include your own sketch through a comment and link back in your post. There are no themes. Choose any emotionally charged life experience, and write.
