Archive for the ‘Nurse Kate’ Category

Nurse Kate Heals

Wednesday, August 3rd, 2011

One night, early in my nursing career, we admitted a patient to our med-surg unit from the ER. He was well into his 90’s, a retired physician and a dapper gentleman, well spoken, great sense of humor. I did his admission paperwork and tucked him in to sleep. It crossed my mind to put the “bed exit alarm” on due to his age, but he seemed 100% “with the program” and I decided not to affront his dignity. A short while later, one of the brand new grads came tearing down the hall in hysterics looking for me. She was stammering and white as a sheet. I entered the room and saw blood everywhere. My alert and oriented little doctor-patient had ripped out his IV, and worse, his foley with an inflated balloon. He was standing there stark naked with blood pouring out of his penis. I thought the new grad was going to faint! We assisted him back to the bed, and I grabbed a washcloth and proceeded to apply pressure to the bleeding penis. He realized what he had done, and was a little sheepish. The new grad said, “Oh my God, are you in pain?” With a twinkle in his eye he said, “No, it doesn’t hurt, but why don’t you wiggle it a little and we’ll see if it still works!”

During one of my clinical rotations in the critical care unit, a patient came in with a police escort. He had ingested some illegal substance and alcohol and had been acting violently for several hours before passing out. He arrives still konked out after ER has figured out what he had ingested, along with large amounts of alcohol. The nurses inform the police officers that if he is to be arrested when he is in a alert state, they have to stay there. We are informed he has several charges against him and they have been looking for him for sometime before this.

Before shifts ends, this man awakens in restraints, and tells the police officers in his room he needs to use the restroom. We ask that one officer stay in his room while he goes, and draw the curtainf or privacy. The man refuses so the police officers decide that since the windows can’t be opened and they’ll be right outside the door, its ok to let him stay in there alone.

We wait and wait for him to get done…waiting…waiting..and finally one of the officers decides to check on him…and lo and behold…HE’S GONE…
2 of the ceiling tiles are missing, we go to call security when we all hear a great crash.
Our guy has fallen through the ceiling 2 rooms down – right on top of a 86 yr old woman recovering from a massive heart attack. Luckily, the woman suffered no injuries, but she did cuss him out something fierce!

Nurse Kate Heals

Wednesday, June 15th, 2011

Okay you have been warned…

A few years ago a person presented with a headache and dizziness. Of course, there can be many reasons for said symptoms, so the usual array of tests were ordered including a head CT. Here comes the gross part..CT results: tapeworms in the brain. Yeah worms in the brain. Allow me to explain…

These parasite can live in pork. If the meat is undercooked guess what happens? Right into your tummy and attaches itself to your intestine. When it enters your body it is in an immature stage and it matures in your intestine. The worms lay eggs. Lots and lots of eggs. They pass out through your stool. You don’t wash your hands, your hands go in your mouth at some point and with it go you know what. These eggs can enter your bloodstream and travel to different parts of your body including your brain. They mature into worms there.
They can cause dizziness, headaches, vomitting, sometimes seizures. The treatment is drugs that get rid of parasites and steroids. Sometimes surgery is required. They can kill you if they affect the brain stem.

I don’t think I’ll ever eat pork again. I love my job.

Nurse Kate Heals

Tuesday, May 31st, 2011

Had a weird couple of nights this week….

1- A man was seen walking around the parking lot with a roll of toilet paper on a leash. He said he was looking for his mother’s cat that took a cab to the hospital.

2- A 24 year old who came in for an ankle sprain…but was also grossly infected with scabies.

3- A 21 year old man called EMS for a toothache. I am not sure why they actually brought him…but they did. He walked in through the ambulance bay with the paramedics and his girlfriend, who had a bag of cheetos in her hands. I guess she needed a snack for the ride. When I directed them to go to triage, he got mad and walked out the hospital. Ooops.

4- A 37 year old man got released from drug rehab. He decided to celebrate by getting drunk and passing out on his porch and knocking out a couple of teeth.

5- A 22 year old female wanted a mammogram to see how far along in her pregnancy she was.

6- A 45 year old female came in intoxicated. She was afraid she was pregnant, so she decided to get drunk and do drugs to kill the fetus. But when she got the room, she decided she wanted to keep the kid (it would have been #9). Thankfully she wasn’t actually pregnant.

7- A 37 year old male came in after getting “jumped” by 10 guys and 5 girls. Of course, he said they jumped him for no reason. On review of his past medical records, I learned he was seen a few years ago after being jumped. Somehow…his keys got stuck in his ass when he got jumped that time.

8- A 27 year old came in for a drippy dick. We counted on the electronic medical records that he had been seen TWENTY THREE TIMES in the past 2 years for a STD. Nice…

Nurse Kate Heals

Thursday, May 12th, 2011

So a 500-pounder came in the other day with something, and she claimed vehemently that she couldn’t move herself and needed a bunch of help for everything, including taking a whiz.   Really?  You can’t turn yourself?   You live alone, but can’t get yourself up to the [special, reinforced, military-grade ironclad] commode?  Yeah right, whatever.

So since no one is going to be able to do a “max assist of 100″ on a 500-pounder to the commode, we decided to just put a couple of big pads and diapers under her and see what happened.

Have you ever seen urine dripping off an ER cart onto the floor and running into the hall?  Yeah, that’s what happened.  Somehow, she managed to only hit a portion of the absorbent pad and voided about a thousand cc’s onto our floor.  Um, housekeeping?

So we got six, count ‘em six, people to help turn her (more like a tilt because the carts aren’t wide enough for a full turn), cleaned her up (which is fun because you have to go to like mid-forearm to properly clean the asscrack area), put on a bunch of new linen, and voila!  There you go.   Clean as a fucking whistle.

So, an hour later, oh, well, lookie whose call light is on.  Ms. Five Bills.  Now Ms. Five Bills has to have a bowel movement.  People are like clocking out early, running to the parking ramp, etc. to avoid helping.

Me?  I pull the ironclad, military-grade, special-reinforced bariatric commode up to the bedside and say, “You’re not going to have a bowel movement in the bed.  You’re going to sit on the commode and do it there.  All my coworkers are hiding in storage rooms, so there’s no one who can help.”

But I’m too sick, I can’t move. I need help!  Don’t you people want to help me?  Blah blah.

“Nope, you need to get yourself up and sit on the commode.  Homey ain’t playin’ dat no mo.”

So she sat herself up without so much as a tug on the siderail, swung her massive leg-trunks over the side, walked over to the commode, and plopped down to take a shit.

Five-hundred pounders have personality disorders too.

Nurse Kate Heals

Friday, April 15th, 2011

Nurse Kate is sitting at home recovering from orthopedic surgery. It was especially fun, as they kept me awake because I react poorly to general anesthetic. This entailed getting a nerve block in my upper leg. For those of you who had never had it done, it’s a really weird feeling. They stick a very large needle into a deep nerve in the back of your leg just above the knee. Then they flick the needle, and if it’s in the right place you can feel it vibrate in your ankle. Veeeeery strange. It’s probably a good thing I couldn’t see when they stuck the needle in my leg because the bruise is very deep and very sore.
 
So, off to the surgical suite: They put you in a table that has a beanbag top that molds to your body because the table is very narrow and easy to roll off of if you aren’t sound asleep. They put a drape between me and my foot as most people looking down and seeing their foot laid open would probably scream/faint/vimit, etc. Unfortunately with a curious nurse stoned out on midazolam they had to remind me repeatedly to stop sitting up and trying to watch the surgery. They were kind enough, however, to bring me one of the enormous bone spurs in a specimen container so I could see it. No, I didn’t get to keep it.
 
The surgery was a little over two hours, but it didn’t seem that long. I suspect that after the umpteenth time they had to tell me to lie down they might have pumped up the sedative. I’m looking forward to my followup appointment with the surgeon to find out exactly how annoying I was.
 
Anywho, heres some stories from the ER:
 
There was the “buffy” type college sorority girl who complained about a “bump” on her genital area. Said it had been there for a month or so. The doctor performed a pelvic exam, found normal female genitalia, and then accidentally bumped the clitoris. “That was it!” the patient said. “What, this?” asked the doctor, not realizing for a second that he didn’t need to be manipulating the clitoris too much…”yes, that’s the bump!” He had to gently explain that that bump was SUPPOSED to be there and, in all likelihood, had been there a little longer than a month!
 
A very intoxicated young lady was brought to the ER by the police for a pelvic exam following a drug bust. They felt she had secreted a small stash. The doc found a parcel all right! A small order of McDonalds French Fries wrapper in all. Apparantly, the girl was in a real hurry and grabbed the wrong package.
 
One night while sitting at the station, I noticed a Foley cath, balloon fully inflated on the floor, and a naked toosh walking down the hallway. After running to catch the man, who was in his 80’s, he spun around to show me his handiwork. After pulling out the catheter, to prevent furthur trauma, he took off his hospital gown and tied off the base of his penis like a tourniquet to stop the bleeding.

Nurse Kate Heals

Wednesday, March 30th, 2011

From across the pond…
 
Picture this 2200 late shift. Phone call from A & E (or ER if you are in the USA)
“We have an admission for you”
A& E is not supposed to admit to general wards after 2130 (they usually go to the “holding ward” until morning, so we knew this must be a doozy.
A & E – “She is mobile, continent, orientated and alert, she has a lower leg wound that the registrar wants a dermatologist to look at ASAP”
Me – “Why isn’t she going to the holding ward?”
A & E – “There isn’t any room”
Me – “OK send her up, we’ll cope”
So we start to get ready for this admission, put the water jug next to the bed in a six bed bay and all the rest of it when we smell this most disgusting smell! We start to wander around the ward and this smell is getting stronger and stronger. Then we look up and here is a wardsman coming down the hallway with an obese woman in a wheelchair with an enormous number of bluies tied around both legs. He has a mask on but still looks a little worse for wear.
We realise this woman can’t be put in a 6 bed bay and have to rearrange beds to get her into a single room.
We do this eventually and I get to take the admission as I was the fool to take this patient at this time anyway. I remove the blanket from around her shoulders and the corners of the blanket stay stiff it was that dirty.
I ask her why she has come to hospital.
She says; “Coz of my legs”
Me; Ok what’s wrong with them?”
She says; “They’re sore”
Me: “Do you treat them with anything?”
She says; “When they get bad I give them a spray”
Me; “What with?”
She says; “Mortein or something”
At this stage there is a foul smelling semi opaque serous-looking fluid oozing from under the bluies and I know that what I am going to find there is not going to be pretty.
I take the bluies off and the skin underneath is undulating! She had an entire ecosystem living there!! It was horrendous, like something out of a horror movie!
Eventually the derm diagnosed this disease with a long name that excapes me that made her lower legs have skin like a crocodile, it would split occasionally and that is when the bugs would get in. This disease was primarily caused by simple poor hygiene it seems.
Anyway the treatment was to put her in a warm bath and exfoliate her legs. I won’t gross you out with those details. Needless to say she wasn’t called the Cornflakes lady for nothing!
To top it all off this woman was discharged eventually because of her innappropriate sexual behaviour. She would moan and call us darling when we massaged her lower legs with moisturiser to soften the skin. She would touch us innapropriately and smirk at us.
An all round disgusting person!
We were glad to see the last of her!

Nurse Kate Heals

Friday, March 25th, 2011

Another collection of nursing stories from nurses all over….
Be prewarned, this is going to be one of the gross ones.
 
Quite a few years ago, I was working in a trauma/general surgery ICU. At the time, I was doing permanent weekends and was working with a great group of people. Anyway, my friend Jan asked me to come in and help turn this poor elderly trauma patient who had hip surgery s/p a MVC. Well, the hip was quite swollen, inflamed and red and definitely looked infected. Jan must have had some kind of premonition because as I and a fellow coworker turned the patient towards us, Jan yelled “hit the deck!” (which was pretty funny considering Jan was an ex-Army nurse). The next thing I knew, Jan was on her knees, the hip wound burst open and signicant amounts of yellow pus and sh*t went flying and spattered on the wall and curtains. Totally gross and thank God for Jan that she “hit the deck” at the right time! I shudder to think what she would have looked like had she not dropped. Needless to say, the patient made a quick trip to the OR.
 
I think my 2 most gross stories were a few years ago I worked for a new M.D. (fresh out of school and this was his first practice) he and I were doing and I&D on an abdominal abcess on this elderly woman in the office, well he did the incision and the smell was making me gag, and she was just yacking and yacking (and I’m thinking how can she handle this smell) I look over to him (we had a way of talking without talking) and when he went to drain this abcess it literally squirted him in the eye. The whole time the smell is making me sick to my stomach and I’m blotting his eye with gauze and then made him let me rinse it out….. bodily fluids just attract to his eye I suppose. A few weeks later, we were doing a simple Pap and when the speculum clicked in the open position this girl’s vaginal fluids squirted in his eye again…. I finally bought him some goggles and told him he was to do nothing pertaining to anyone’s body fluids without them…
 
It was my first job as a new grad. I was working telemetry nights. Often I would sit next to the monitor tech and watch and learn. “What’s wrong with that one,” I said. “She’s dying!” the tech replied as he vaulted over the desk into the patient’s room. Naturally, I followed. Patient is asystolic by now. I began doing chest compressions. This was a sixty something female, s/p ventral hernia repair. It was my very first code!!! After about 30 seconds of compressions, her suture line split, and her entrails spilled all over her lap!! Now, that’s what I call a code!
 
I remember one time working in an ER and a young man came in. He had been drunk and had fallen from a high distance and landed on his head. Needless to say we were performing CPR on him and with every compression, blood came out of every orifice in his head. He didn’t make it……
 
This is one that happened in the resuscitation area of the Emergency department where I work. We had a code blue call come in with a patient who had arrested. in the department CPR was continued and he was shocked several times when the medical resident on call decides to shock the patient once again and try one more cycle before stopping. She was on call and had been in the clinic so she wasnt wearing scrubs or a Dr’s coat, but a very nice trouser suit and had just had her hair done that morning.
She placed tha paddles on the patient and shocked him as she did so the patient as a reflex response ejaculated straight into her hair and over the side of her jacket. The funniest part of this was that she didnt actually notice and carried on working on the patient and couldnt for the life of her understand why all the staff in there with her kept crying with laughter whilst still working. It wasnt until the end of the arrest that anybody told her what had happened, where upon she sprinted to the toilet to clean herself up and be sick.

Nurse Kate Heals

Tuesday, March 8th, 2011

A couple of stories from a doctor:
 
Today just wasn’t my day in the emergency department.
 
First, I’m taking care of a patient with shortness of breath. I’m standing at the side of the cart. He leans forward and I listen to his lungs with my stethoscope. Sound good. Then I lean the bed back a little so that I can listen to his heart and press on his abdomen. The sides of the cart are up and I usually just lean over the sides of the cart to put my stethoscope into position.
I rest one hand on the cart rail and lean over with the stethoscope in my hand to listen to the patient’s abdomen. Well the damn cart rail wasn’t locked into place, so when I lean on it, it folds down and I lose my balance … falling forward into the patient … and the side of my head lands firmly in his genitals.
 
Yes, I accidentally headbutted my patient in his crotch.
 
He yells out and instinctively pulls his knees up. I’m struggling to keep from falling on the floor. I wobbled to my feet as the respiratory tech peeked her head in the door to see what was happening. All she could see was my head rising up from the middle of the patient’s bed and the patient curled up in a fetal position.
 
I just looked at her for a few long seconds. She looked back at me. I felt my face getting red and couldn’t think of any smart ass comment, so I said “Don’t ask. Just … don’t … ask.”
Then the patient started cracking up … in a slightly higher voice than he came into the hospital with.
 
The fun wasn’t over, though.
 
A little kid gets brought in by his parents because the mom thinks the child has an ear infection. Every time that someone walked in the room, the kid started crying uncontrollably and climbing up mom’s chest to get away. As soon as staff left the room, the kid was fine again.
When I tried to examine the child, the mom wanted me to do the exam with the kid sitting on her lap.
 
Personally, I like laying the kids on the table because it is easier to control their movement when trying to look in their ears and their throats. The mom was insistent that I examine the kid while sitting in her lap. I reluctantly agreed.
 
When I started to go near the kid, he started wigging out. Shaking his head back and forth, squirming all around, flinging his arms every which way.
“You’re going to have to control him better or I’m not going to be able to examine him properly.”
So mom pins his arms to his sides and holds him tight against her body. Dad is just sitting in the chair against the wall.
I got closer to look in the kid’s ear and he starts squirming again. He starts wiggling his body so he is sliding further and further down onto his mother’s lap. I’m getting ready to tell the mom that we really need to put him on the table and then …
 
WHAM!
I see stars.
 
A 19 month old kid nearly brought me to the ground with a kick to the crotch. This wasn’t just any kick, though. Now that the child realized he had a leverage point, he hooked his foot there for a second and started pressing his foot against my leg to try to squirm free. The only problem was that my left gonad was between his foot and my leg. I doubled over, started talking like Pee Wee Herman, and limped out the door.
Don’t worry, lady. I’ll just write him a script for some Amoxicillin after I get done puking in the bathroom.
 
Never thought I needed to recommend athletic cups for use in the emergency department.
 
And I’m never … ever … examining a kid in the parent’s lap again.

Nurse Kate Heals

Thursday, March 3rd, 2011

Last week I started writing about all the inaccuracies that the media perpetuates about the medical industry. We kick off this week with Comas.
A quick rundown on what a coma actually is:
“Coma may result from a variety of conditions, including intoxication (such as illicit drug abuse, overdose or misuse of over the counter medications, prescribed medication, or controlled substances), metabolic abnormalities, central nervous system diseases, acute neurologic injuries such as strokes or herniations, hypoxia, hypothermia, hypoglycemia or traumatic injuries such as head trauma caused by falls or vehicle collisions. It may also be deliberately induced by pharmaceutical agents in order to preserve higher brain functions following brain trauma, or to save the patient from extreme pain during healing of injuries or diseases.”

There are other states that are often mistaken for coma by the lay public:

Catatonia – People in this state do not move or speak, and tend not to make eye contact with others. It can be a symptom of psychiatric disorders such as schizophrenia.
Stupor – The patient can be awakened only by vigorous stimuli, accompanied by motor behavior that leads to the avoidance of uncomfortable or aggravating stimuli.
Drowsiness – This simulates light sleep characterized by easy arousal and periods of alertness.
Locked-in syndrome – People with this rare neurological condition are fully able to think and reason, but they are completely paralyzed with the exception of opening and closing their eyes (which they sometimes use to communicate). Strokes or other conditions that damage the brain stem, but not the cerebrum, can cause this syndrome.
Brain death – People with this condition show no signs of brain function. Although their heart still beats, they cannot think, move, breathe or perform any bodily function. A person who is pronounced “brain dead” can’t respond at all to pain, breathe unassisted or digest food. Legally, the patient is declared dead and the wishes of the patient or the family regarding organ donation can be considered.

In movies and TV they always show a patient awakening from a coma like they just got out of a deep sleep. In reality, coming out of a coma is usually a very slow process that involves minute changes in the patients responsiveness over a period of weeks or even months.
When we work with them, we assess their responses with neurological vital signs and watch their reactions to our care. Unfortunately, it is very hard to say how fast and to what degree a person will recover from a coma. Some will never progress beyond basic responses to stimuli, some remain mentally or physically disabled, and some recover fully. The outcome depends on many factors: cause of the coma, duration, patient age and health before the injury, and management of the many complications while the person is dependant.
The patient is in an intensive care unit, or specialized neurological intensive care unit. From there they may progress to a neurosciences ward once they are more medically stable.
Luckily, progress is being made on brain injury treatment and new discoveries are being made about the brains ability to adapt around injured areas.
Still, the spontaneous waking and perfect recollection are hollywood fiction and instill unrealistic expectations with people.
As a nurse on a neuro ward, all I would like to say is “protect your noggin!”. Your brain is a fragile thing. Thank you.

Brain Injury

Nurse Kate Heals

Thursday, February 24th, 2011

Working in health care has taken away my ability to watch anything “medicine based” in TV or movies. You know why I put that in quotation marks? Because 99% of it has no basis in reality whatsoever. Unfortunately, just like people who watch Law and Order and “know their rights” (even though it’s an American show and we are in Canada), patients expect their hospital stay to resemble the ones they see on TV. This usually means that they are completely baffled that they don’t see their doctor several times a day and that he isn’t personally performing much of their care. I actually had a patient that refused to let me remove an IV from his arm because it was a “medical skill” and hence a doctor should be doing it. Apparently nurses have no medical skills.
On TV doctors hover around their patients, catheterize them, give their meds, etc. In real life, you will see your doctor maybe once a day or less depending on the severity of your condition. The nurses are the ones that are assessing you, giving your meds, and will be doing most of your medical care. When the doctor does come in, he relies on the information that we give him to decide what course of treatment to take. We are going to be the ones initiating CPR if you code, and the ones maintaining your life support.
Aside from having no idea what nurses do, here are some other things that the media get wrong:

Dead People:

They just look like they’re asleep right? Peachy complexion, eyes closed, slumped a little? You have to approach them and take a pulse to know if they are dead (shock and horror!). The real picture:
There is no blood circulating, the skin is a very easy to spot ashy grey very quickly.
The mouth is hanging open. It takes muscles to hold the mouth shut. At the morgue they loop sutures through your palate to hold it in place so you don’t show up at your funeral looking like the kid from home alone.
Eyes half shut. It requires muscles to keep the eyes fully open or shut. Devoid of any animation, the lids sit at half mast. And no, we don’t close them when a person passes (that tearjerking moment in every scene where someone passes away). We have to check the pupil response to ensure that death has actually taken place.
Bowels and bladder. Ah yes, remember all that talk about muscles relaxing? You’re going to smell that, trust me.
Bottom line, theres no mistaking a dead person for someone sleeping.

Stay tuned for more…

Nurse Kate Heals

Friday, January 28th, 2011

Before Viagra and its cousins, there were other methods of waking Sheriff Woody. They’re still out there, for those who have issues with Viagra.

One of them is Caverject (or Alprostadil for my pharmacy fans). This is fairly effective at getting it up for special occasions. They have to be pretty special, though, because Caverject has to be injected directly into your winkie to work. What fun.

Because it came to market before the era of direct-to-consumer celebrity advertising, we were fortunately spared TV ads featuring Eric Clapton singing (to the tune of “Cocaine”):

“If your lady is hot
Just give yourself a shot-
Caverject.”

But I digress.

I have a patient who’s been using Caverject for years. For whatever reason he can’t use one of the newer drugs. He’s kind of an aging, swinging, disco guy. In the 70’s he was swinging, single, wearing gold chains, and picking up babes at the disco. In 2009 he’s still swinging, still single, still wearing chains, and now picking up aging babes at the disco.

A few weeks ago he had a small stroke (he’s fine now), and as a result he’s now on Coumadin, a potent blood thinner. This gives new meaning to “Stayin’ Alive”.

So last Saturday he was out getting his boogie on and picked up Ms. Agingdiscoqueen. They went back to his place for some wild times. He shot himself up with Caverject and the fun began.

And abruptly ended. Apparently she got on top, and while she was riding the disco pony, blood began squirting out the side where he injected Caverject (thanks to Coumadin). Seeing blood flying all over those areas killed the mood fast. She ran out, and likely went home to douche with bleach.

He’s visiting his cardiologist today, to discuss stopping Coumadin.

Thus endeth the 70’s.

Nurse Kate Heals

Thursday, January 13th, 2011

A 90-something-year-old woman, who had, by all reports, been doing “fine” at an assisted living despite mild age-related dementia, suddenly became paranoid and began acting out. She was yelling, attempting to hit people, etc.

Maybe she thought it was the end because she had some dirty laundry to air in our fine acute care facility.

First, literary critics, we have the foreshadowing to the big secret.

[Aide attempts to draw labs from patients arm]

Elderly woman, slapping at the aide: Don’t touch me! I’m a hooker and have gonorrhea. You don’t want to catch THAT do you?

Then, some time later, she beckons for the male nurse to come over. In a whisper, we have the big reveal:

Elderly woman: You know, I like you. You’re a handsome young man, so I’ll tell you something. I used to be a high-up official in the Catholic church, but they fired me from my job…because I was selling the pussy.

I just about died when I heard that.