Stat Stories

Brain Pain

whitney — Wed, 23 Sep 2009 04:27:00 GMT

Subjective Data:

Name: Whitney

Address: Baltimore

Sex: Female

Race: Caucasian and very pasty. Pt. Denies being able to go outside for any sun exposure.

Dependents: None. Pt. states, “Thank goodness. I wouldn’t have time to even feed them.”

Contact Person: God. He’s the only one that can help!

Source and Reliability: Whitney, the pt., is reliable.

Chief Complaint: “My brain hurts.”

History of Present Illness (HPI):

Pt. first began noticing brain pain at the beginning of September in 2009 when school started. Beginning in September of 2009, pt. noted sleeplessness, increased anxiety, irritability and a decrease in concentration. Pt. eats well balanced meals, gets regular exercise 5-6 days/week, and recently tried a YOGA class in an effort to relax and relieve stress.

Past Medical History (PMH):

General State of Health: “I could be a Navy Seal I’m so healthy.”

Major Childhood Illnesses: None

Current Health Status:

Allergies: Tests (Hives), Homework (Hives), and especially Research (Anaphylactic Shock).

Immunizations: Up-to-date.

Exercise and Leisure: bike/run/walk/swim 5-6/week

Current Medications: None

Personal Habits:

Tobacco: None

Alcohol: 1-2/week with friends (pt. is above 21 and does not drink and drive!)

Caffeine: Continuous IV infusion

Illegal Drugs: None

Diet and Nutrition: A variety of Whole Food specials and School of Nursing Me Latte items. Pt. states, “I don’t have time to cook.”

Primary Care Provider:

Dr. George Clooney and Dr. Pierce Brosnan

Family History:

We are all a little special.

Me:

Doc, just tell me what’s wrong already. I have work to do. Let’s skip the objective/review of systems (ROS) part. I thought Electronic Medical Records (EMR) were supposed to be faster and more efficient.

Doc:

Well, Whit it seems you have nursing schoolinflamatitis related to course work. Brain pain is a classic sign for schoolinflamatitis. I see it all the time. Very common. I recommend that you take the weekend off from studying and give me a call next week.

Me:

Are you going to charge $1,000 for that diagnosis? If you are, you better give the fabulous nurses a raise!

Meeting Ben Carson

whitney — Wed, 16 Sep 2009 19:04:00 GMT

I have read three of Ben Carson’s books, and I have been impressed with all of them. For Christmas, my mom got me his book, Gifted Hands, and it was my favorite present that year. I was a Ben Carson fan after reading the first sentence, and I knew he was someone I wanted to meet. I quickly added him to my “Must Meet before I Die” list. I now have one less person on my list because I got to meet him last night after his lecture.

He was everything I had imagined him to be except that he spoke in a much softer voice than I had imagined. He had such a calm voice. Exactly the kind of voice I’d want to hear if a doctor walked into the room and said, "Whitney, I’m going to crack your skull open, fix a bunch of stuff in there and then I’m going to put it all back together. As you know with any surgery, there is the risk of death. Now just sign this consent form and we will be on our way."

He was methodical, honest and respectful as he answered student questions from the audience. I appreciated that. Also, I found him to have a charming sense of humor that I don’t remember being expressed in any of his books. That was a great surprise!

After his lecture, I got him to autograph my nursing journal, and I got two pictures with him. Not a bad way to end my day.

Hopkins Summer Experience

whitney — Wed, 16 Sep 2009 18:16:00 GMT

Welcome back blogger fans! School is back in session and the semester is well on its way. Before telling you about my current semester, I need to bring you up to speed on how I spent my summer.

I spent three months working in the Weinberg Intensive Care Unit (WICU) at Johns Hopkins. The WICU is a surgical oncology adult intensive care unit where we primarily care for patients that have undergone some type of surgery in an effort to have a cancerous mass removed. You may have heard of the Whipple procedure. If you haven’t, you should look it up at http://pathology.jhu.edu/pancreas/whipplePop.html. I don’t remember a week going by where we did not have a Whipple patient. For all you Whipple fans, I know what you’re thinking. Did you get to see Dr. Cameron? Yes. I saw Dr. Cameron almost every day. He is an early bird. In fact, he is seeing patients before the birds start singing in the morning!

Working this summer gave me the opportunity to put my nursing knowledge (especially pathophysiology and pharmacology) and my nursing skills into action in a carefully guided and safe way. I recommend that future nursing applicants really consider the traditional programs because you will have a summer in between your first and second year to digest what you have learned from the first year and a chance to apply some of your knowledge to the nursing field. You can sit in a class all day and no matter how interesting or great the class and professor are it will not compare to work experience.

My Typical WICU Shift

1. Come 15-30 minutes early to get patient assignments, review patient history and design worksheet in hourly increments. This is most important for time management.

2. Meet with nurse and other people taking care of patient and listen to a report on the patient.

3. Go talk to the patient! Tell them your plan for the day and get to know them! One of my favorite parts of the day.

4. I did my beginning shift tasks and then I went on rounds with the nurse practitioners, doctors, pharmacists and other nurses. This was a time for me to think about the reasons behind the care for our patients. It was a great processing time. Everyone was great to explain things to me and I always got great diagrams, handouts and articles from rounds.

5. Continue with my hourly nursing tasks and read the patient’s chart in between nursing responsibilities.

6. I made an effort to read at least one article per shift pertaining to an ICU issue or procedure. I think it’s important to build your foundational knowledge bank! Nurse educators are great resources and I found that medical students, residents, pharmacists, and attendings were all more than happy to share and explain information to me. That’s the beauty of working at a teaching hospital. People expect questions and are there to teach among many other things.

7. Clean and organize the room. No Clutter and No Germs Allowed near my sweet patients. I love the Caviwipes and hospital heavy duty Clorox wipes! They are our friends.

Warm Weather: Where Are You?

whitney — Tue, 24 Mar 2009 17:31:00 GMT

I’m back from Spring Break! I enjoyed most of my break, and I’m ready to finish out the semester. More than anything, I am ready for the warm weather to arrive. I am studying for tests for the next 10 days; therefore, I may temporarily be absent from the blogging world.

I will tell you that my psychiatric nursing rotation starts Thursday, and I will be blogging about some of my interesting experiences! Keep checking back.

Have a wonderful day, and I hope wherever you are it is warm.

Whit's Birth Plan

whitney — Sat, 28 Feb 2009 05:23:00 GMT

Plan A: Adopt so I don’t get fat, my hips don’t expand and I don’t get stretch marks.

If for some reason my choice of contraceptives fails me and I become pregnant, the following should be done for me as long as I am not a high risk patient and my fetus is healthy.

Plan B

1. Do not take me to the hospital until my water has broken. I want spontaneous ruptured membranes.

2. Do not give me Pitocin prior to the delivery of my baby. My body will release Oxytocin and things will progress naturally as they should.

3. Do not give me an epidural. In my opinion, it is an unnecessary risk and intervention. Also, don’t give me narcotics during labor. It crosses the placenta, and I’m not comfortable with that. If it was just me going through the labor process, I would gladly accept pain medication; however, it is no longer all about me.

4. Do not perform an unnecessary cesarean section on me. It is a major surgery with serious risks that I’m not going to take unless there is an emergency situation. My child is coming on its own schedule, not yours. This is not always a convenient process.

5. Do not forcefully stretch my perineum in an effort to force my child to come out of the birth canal. Have patience.

5. Do not give me an unnecessary episiotomy. Again, have patience.

6. Do not yank my placenta out unless it has been an hour post delivery. Children require patience, and it all starts with the birthing process.

7. Provide a tummy tuck as well as a reshaping of the abdominal region. Yes, there is a risk, but the risk is to me and not to my child. I will be a much better mom if I do not have an overhanging muffin top. Without the tummy tuck and reshaping of the abdomen, I will be at an increased risk of severe post-partum depression.

* Notice this is my birth plan. It is perfectly acceptable and within your rights to have a different one. I am also aware that even the best of plans do not always work out as intended. It is important to remember the ultimate goal which is to have a healthy and safe delivery!

Student Accepted Day

whitney — Thu, 26 Feb 2009 04:56:00 GMT

If you are an accepted student coming to Baltimore for Student Accepted Day, then you need to read my blog posting.

In February of last year, I was headed to Baltimore to meet my future friends. I wasn’t nervous about meeting all the new people, but I was concerned about what I was going to wear. Your packet says to dress casually. Let me define that term for you in case you are from the South. It means to wear jeans and flip-flops. I was not familiar with this definition of casual dress. All of the West Coast students understood this; however, I did not. I wore nice dress pants with a matching top. I define casual dress as wearing dress pants, forgoing the blazer and lined skirt. I looked like I was going to give a presentation. After the first two weeks of school, I started wearing jeans so that I blended in with the student population instead of the faculty.

Student Accepted Day is a great time to meet your future classmates and faculty without the pressure of studying. We, the current students, get so excited about the new kids. You guys are the topic of conversation at lunch! We are constantly getting emails from Mary O’Rourke, the director of admissions, about your much anticipated arrival. There is a lot of excitement in the School of Nursing, which you will come to know as SON. I can’t wait to see you! I intend to stop by SON before going to my clinical on Friday.

Top 5 Reasons to come to Student Accepted Day

1. You get a free tote bag.

2. You get free breakfast and lunch. The current students get to eat your leftovers. Yum.

3. You get a student discount on your nursing apparel at JH Matthews bookstore. JH Matthews will be where you spend most of your future money as a student.

4. You will meet Mary O’Rourke who is one of the funniest people I know.

5. You increase your chances of finding a good roommate (if you need one) by coming to student day.

Deliver Me

whitney — Thu, 26 Feb 2009 03:56:00 GMT

I just got back from working the afternoon/night shift in Labor and Delivery. I function so much better when the moon is out and not the sun. I got into my scrubs, and before my instructor gave us our assignments, a nurse said room * was about to deliver, and she wanted a student. I jumped at this opportunity. I am quite an aggressive individual. I flew into the room, and within 45 minutes to an hour, she gave birth. I helped her: push, gave the baby his vitamin K, Erythromycin ointment in his little eyes, weighed him, stretched him out and measured him, watched the doctor stitch the patient back up, took family photos, got to know the entire family and all their stories (some family drama going on for sure), investigated the placenta in great detail with my hands, felt the uterus, etc. When he was delivered, he looked into my eyes and said, "Thank you for getting me out of there." I replied, "No problem. You are perfect, beautiful, and you have wonderful parents waiting to get to know you." I stayed with the patient and family the entire time they were there. Just the way I like it. They wanted pictures of me and the baby. Isn't it supposed to go the other way around?

Oh Baby!

whitney — Wed, 25 Feb 2009 20:45:00 GMT

Oh Baby!

Let’s get reacquainted. I had a wonderful Christmas, New Year’s Day and six week hiatus from nursing school. Now I’m back doing my OB rotation, and I have three weeks left. Let’s talk about those babies.

First, I can’t help but think of Cliff Huxtable on the Cosby Show while doing my OB rotation. In case you blogger fans don’t know your Cosby trivia, he was an OB/GYN who somehow managed to be the perfect father of five while maintaining a perfect marriage to a successful attorney, Clair Huxtable. His pager never went off at inopportune times, and he was always available for weekend fun and family evening activities. How did Dr. Huxtable do that? Well, I’ll tell you. He had great nurses!

I’m going to give you some OB terminology that I have found entertaining.

1. Expected Date of Confinement (EDC) refers to the date we expect the baby to leave the comfort of the uterus and make its debut into the post uterine world. Confinement? Confined to what? Confined to the house? That thought deters me from reproducing. We cannot say Estimated Date of Delivery (EDD) because patients complained that their babies were being talked about like groceries. I have a question. When was the last time you got your groceries delivered or knew someone who did?

2. Passenger refers to the baby while inside the uterus. I wonder if the passenger gets free peanuts. I know I don’t when I fly, and it makes me mad every time. I remember when I asked for peanuts, and the stewardess said, “Oh, I’m sorry. We don’t give peanuts anymore, but I have pretzels.” The airlines want you to think the reason for not giving peanuts is to protect those individuals with peanut allergies. However, I later watched the Discovery channel, and I learned that by removing 2-3 peanuts from each bag saved the airline company multimillions of dollars. Money is the motive.

3. Fetal Presentation refers to the part of the baby that comes down the pelvis first. Did you know you made a presentation before you were even born without the use of PowerPoint?

4. Fetal Attitude refers to how the different body parts of the baby are situated. It’s not just teenagers that have attitudes. Babies have them too!

5. Uterine Soufflé is a uterine bruit. I never associated dessert with uterine activity until now.

I intend to post another blog related to a specific OB experience later today!

Dear Santa

whitney — Wed, 24 Dec 2008 00:25:00 GMT

Dear Santa:

I apologize for sending my letter so late this year. I was busy being good J I hope it reaches you in plenty of time. I sent it FedEx priority overnight!

How have things been at the North Pole? Cold? It’s been terribly cold in Memphis lately. I need you to bring a little warmth this year. Okay, here’s my list you’ve been waiting for all year long.

School of Nursing desperately needs new chairs in lecture hall 114.
Welch library needs electrical outlets in the study cages for laptops.
School of Public Health is in dire need of projection screens. They have to use overhead projectors and transparency sheets in some classrooms.
School of Medicine needs projection screens for the lecture halls. They still have chalk boards. Santa, help!
We need another parking garage. Parking is atrocious.
Please assign some of your elves this year the task of redecorating the hospital. It needs a little sprucing up. I think it would help the patients feel better.

*Santa, I have been such a good girl this year.

Do send Mrs. Claus, the elves and all the reindeer my love.

P.S. Remember, if you get sick, come to Hopkins. You may want your reindeer to drop you off in the loop since parking is such a nightmare.

Love,

Whitney

To-Do List

whitney — Tue, 16 Dec 2008 13:00:00 GMT

I just finished finals and came out alive and well! I have a six week break, and I’ve been developing my to-do list. So far I’ve got the following.

1. Flip my mattress for it has been 3 months

2. Redefine my abdominal six pack

3. Increase my VO2 max by 2%

5. Get my eyebrows waxed before going to the airport

6. Get fake nails put on for all the upcoming Christmas parties. I haven’t had painted or fake nails since school started. I didn’t want to harbor nasty germs under my nails and then spread them to my immunocompromised patients. Aren’t I so considerate?

7. Get my acrylic (waiting for the porcelain one to come in) tooth fixed. It broke as I was eating a cookie last night.

8. Pick up Tom Brokaw’s book Boom!

9. Pick up The Time Travelers Wife by Audrey Niffenegger

10. Catch up on all my CNN podcasts

11. Catch up on 30 Rock

12. Organize my 2,000 Picasa photos

13. Catch up on Facebook gossip

14. Blog

Picture Problems

whitney — Sat, 08 Nov 2008 18:48:00 GMT

I put up 21 pictures earlier today on my blog; however, I took all but three down because they appeared on the main student blog page. My pictures took up all of the recent addition photo slots you see when you go to the main student blog page. I don’t want to be a blog hog. So, I will talk to I.T. about a better way to post pictures. I know there’s away, so be patient blogger fans J

I just got done with a four hour Saturday class, so I’m going to reward myself by watching an episode of “The Office.” I can’t wait to see what Dwight has been up to lately.

Have a great weekend!

I Dream of Clooney: Will He Grant Me 3 Wishes?

whitney — Sun, 02 Nov 2008 23:42:00 GMT

I did not get my beauty sleep last night. Constantly, I kept waking up in a state of panic only to go back to sleep for a mere hour or so before the next episode. You can thank George Clooney for my sleeplessness and any grumpiness I may demonstrate toward my classmates tomorrow.

In my dream, George happened to be an assistant for Dr. Szanton’s aging class. I got my paper back, and I received a 60%. I was livid. I spoke to George in the most composed tone of voice possible and said, “George, I did not deserve a 60% on this paper. We need to talk.” He mockingly replied, while laughing with his flat and thinly shaped teeth smiling back at me, “Oh yes you did. In fact you deserved a 50%.” At that point, I lost it. I rolled up my paper, as you would a newspaper to discipline your dog, and used it as a tool of emphasis as I continued to state my case. I made one point after the other of why I deserved a better grade. With each point I made, I took one step toward George as George took one step away from me until he was up against the wall.

I know what you’re thinking. It was here in the dream that I passionately kissed George and he gave me an A for excellence! Unfortunately, that is not what happened. Instead, I told him I was going to have to leave, gather my thoughts and composure, and we would finish this conversation tomorrow.

Can someone interpret this dream for me?

So far I’m thinking:

1. I care more about my school work than George Clooney.

2. I believe there is a need for more male students in the School of Nursing.

3. I am anxious because Dr. Szanton has kept us in suspense over our papers for three weeks.

4. Maybe I should be a lawyer.

//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Oh, and George, I'll have to get back to you on my three wishes :)

Pain and Torture

whitney — Thu, 30 Oct 2008 17:14:00 GMT

Did you know P.T. stands for Pain and Torture and O.T. stands for Other Torture? I didn’t either until my patient today enlightened me. Also, he kept raising his arm straight up in the air every time he saw the physical therapist. I thought this was a slightly strange way to greet someone, but I have seen stranger. It was later that I learned he referred to her as Hitler and the occupational therapist as Stalin. Then I understood his arm gestures. So, do you get the idea he does not like going to therapy? He was quite the character. When he got up from his wheelchair, he told a patient facing his dorsal side he would give her a show for 2 dollars and 50 cents. Those open backed hospital gowns have their advantages I suppose. It was quite a task keeping him in line; that’s for sure.

Despite his feelings toward therapy, it was a great clinical day. I felt I had made progress with my patient, and at the end of the day, he told me he really enjoyed spending the time with me. This was comforting because I did not want him assigning me the title of another evil dictator. I’m aiming for something more along the lines of Mother Teresa.

Lovin' Learning

whitney — Thu, 30 Oct 2008 03:45:00 GMT

It’s a great fall night. My fake fire place is on (I don’t have to clean up ashes), and I have a Yankee vanilla candle fumigating my recently cleaned apartment. I love the smell of vanilla and pine sol. Ah…and I have my balcony sliding door open to let a little fresh fall air in as I wrap up the evening. I have clinical tomorrow. Only three more weeks left of my rehabilitation rotation, so, I want to share with you a few things I’ve learned.

I have learned how important it is to patients that you listen to them. For those of you who know me outside of the blogging world, you know that I love to talk. I’m not quite sure why. Truthfully, I think it may be part of the way I process life experiences. I very much follow the continuum theory which says (and I paraphrase) a person must process or compartmentalize phases of life before s/he moves on to the next phase of life successfully. That’s my best guess to why I like to talk so much. Despite my love for talking and storytelling, I have learned that listening is not only therapeutic for patients, but it is a fundamental part of patient care. If you don’t listen and begin developing your thoughts about the situation too soon, you will miss very important information that is instrumental in taking care of your patient.

Also, I have learned to never ask a patient why. For example, why did you not take your medicine? This is contrary to my way of thinking. I always want to know why someone did what s/he did or did not do, and I always want to know why something works the way it does. Why? Why? Why? It’s my favorite question. I think that’s the most effective question a person could ask. Answering a why question tells you so much information without having to ask multiple follow-up questions. For example, if the patient answers, “I did not take my medication because I can’t afford it right now, and I don’t have insurance because I lost my job” after I ask a why question, then I already know a lot. I know the patient does not have a job and as a result may have some emotional issues along with financial stressors that I could address. Also, I know I’m going to have to figure out a plan that meets his or her medical needs while somehow adhering to or working around our insane health care policies. Look at that. All that information just because I asked one why question. Okay. I’ve made my point. I know Larry King would agree with me. Why is his favorite question too! I understand that asking someone why may come across as judgmental. I can go with that to an extent. So, in the medical setting, I will avoid asking why questions. Instead, I will say, “You know we all forget things sometimes. I forget to take my allergy medicine sometimes. It happens. Is there any particular reason you were unable to take your medication?” So in summary, you ask the patient why in code. By the time I graduate, I will be both a nurse and a diplomat. J

I have also learned how to administer/insert shots, insulin injections, IV, Foley catheters, etc. Oh and I can assess any system you want. It’s your choice. Cardiac? Respiratory? Abdominal? Neurological? HEENT? Musculoskeletal? Of course, I may not know what to do with my findings after I assess you, but I still have time to learn.

Whit's Words of Wisdom: Never stop learning.

Whit's Advance Directives

whitney — Mon, 27 Oct 2008 03:06:00 GMT

1. Put Chap Stick on my lips 3x/day. I prefer Burt’s Bees or Carmex.

2. Clip all of my chin/ear hair PRN (as needed). This is for my emotional well-being.

3. Floss my teeth with minted thin dental floss 1x/daily.

4. Pluck my eyebrows and provide an arch.

5. Turn me every 2 hrs. If I get pressure ulcers, I’m going to be ticked.

6. Do not deposit love artifacts all over my room. This includes stuffed animals, butterfly mobiles, and other unessessary fomites.

7. Do not set my TV channel to Soap Operas. I prefer CNN.

8. Do not rub Johnson and Johnson Baby lotion all over me. I’m not a baby, and besides, it is not a good moisturizer. I prefer Lubriderm.

9. Do not allow me to sleep on plastic hospital pillows. Bring me my tempurpedic curved pillow.

10. Do not feed me hospital food that comes in containers that have built up condensation in the lid.

11. I want my own room. I have already done the college dorm thing, and I’m over it.

12. Resuscitate me and let’s see how I do. If it doesn’t look good after awhile, then let me go on to Heaven where I can eat and not get fat.

Happy Halloween!