all in a day's work!

Wow, I don't know how or why, but I suddenly have an influx of new readers! Totally cool. Hi, everyone!

Yesterday was absolutely insane at work. And even though I barely had time to drink (I'm definitely still dehydrated this morning) and I pretty much had to force myself to go eat, on my way home from work, I really thought, "wow, my job is so cool."

To any experienced ICU nurse, yesterday was just a normal day. But since I'm still new in the unit and on days now, I haven't experienced a lot of scenarios on my own.

When I think about tasks, they all sound so insignificant, as if they go in any sort of sequence when they don't. Everything is happening together, all at the same time. It's insane:
-2 patients
-Both with "lung issues."
-Patient #1: s/p extubation, stable at her baseline dementia. no issues, except for some new CDIFF. Luckily, the RN on night shift placed a dignacare over night, so I had nothing to worry about...

-Patient #2: ICU day 4, procalcitonin (PCT) had double over night. Intensivist was not happy about this. He was on antibiotics, so what the heck? We switched some things around during 'rounds. This patient was the best. She/He was getting out of bed to use the toilet (with my insistance that she/he call me first) and doing ok, but his/jer respiratory status? Not so much. The patient was on 15 liters high flo and when the intensivist decided he/she needed a line and saw how out of breathe he/she was getting back in bed, he/she said he/she wanted to intubate her/him before it got too bad.



I felt sooo bad for this patient because all morning he was telling me that he couldn't believe this was happening. And he even said, "I hope I don't die here." I was like whaaaat?!! stop saying crap like that (on my shift....kidding). He had a great sense of humor, too.

And then suddenly I was running around getting versed, propofol, succinylcholine, intubation kit, suction, calling RT, central line kit, etc etc. All through this, too, she/he/it has blood hanging because the patient's H/H dropped from 9.9 to 7.4.

sigh.


By the time everything finished: intubation, central line wih CVP, vigeleo



Arterial line, bronchoscopy, foley, small bowel feeding tube, portable chest xray, KUB for SBFT placement...I had about 4 pages of orders and an extremely messy room!

But I did it!! The whole time I just kept telling myself, "you rock, you can do this." I had help from the other nurses for sure, but I did it.

And I know if an experienced ICU nurse was reading this, they would think..."ok, that is normal, all in a day's work." And it totally was, and I loved it, but I am just proud and happy that the mayhem finally occurred because in order for me to learn something, I need to DO IT! I did it, and I even got out of work on time, if not earlier.

I am definitely a DO-ER! I'm a Kinesthetic learner.
How 'bout everyone else? Do you learn best by doing (Kinesthetic), seeing, or hearing?
I think we're all a mix of one or two, but have dominant ones. Especially when it comes to my career as a nurse, I've found that if one shows me to do something 34545 times, I will not get it until I physically do it myself. I also learn better and remember once I write it.

Mirza and Max last night:

exerciiiiise

This morning I went on a 30 minute speed walk at the park. On the trail, I passed an old man and politely said good morning. He responded with good morning, too, but then he looked at me and in a very accusatory tone asked, "Why aren't you in school!?!" I said..."um, because...I'm 25???"

hahahah, so apparently I look like a little school girl. Operation look older commences now! I can only imagine what some of my patient's or families think, geez.

After my walk, I went to the gym in my apartment complex and worked on the weight machines a bit. There's only 4 weight machines, but it is better than nothing. The room has bicep curls, leg lifts, lat/row, and a chest press (I think?). I went through the machines twice at 12 reps and then did ab work on the ground, which included 50 crunches, and some planks. There is also a set of 3lb free weights (oh boy...), so I combined the two on one arm and did more bicep curls. I should utilize my actual gym more, but I mostly like it for group classes.
I'm definitely not into machines; I love free weights.


I've decided I need to kick-up my exercise regime. I have 4 days off during my week, so I think I should be exercising 4 days per week. I want to do 3 days of cardio (bla!), 2 of weight training, and 2 of yoga. I went through my gym's group classes and wrote out my schedule for the next week, so now I have no excuses.

I want to increase my muscle. I remember when I joined the gym about 2 years ago and within one month, I had gained 5 pounds of muscle. I felt and looked great. I want to get back to that. Honestly, even though I'm a little person,I consider myself pretty strong. Other nurses agree too when I help to pull patient's up in bed:)


I'm picking up my vegetables from the CSA in about an hour.

Dinner tonight is going to be a recreation of the portobello sandwich I usually get at the greek restaurant, mmmmmmm.

Totally random question: Does anyone like bubble bath?? And if yes, what do you use? I ventured over to Target today for some bubble bath and looked all over in the obvious places, but found nothing. Not even for little kids with cute characters (no shame here). Eventually, I went to the baby/infant section and found some Johnson&Johnson bubble bath and body wash. I bought it. Says it is supposed to "help baby sleep," so we'll see if it works on adults, haha. In all seriousness--anyone?

Daily Dose of Vitamin D

Temperature today is a perfect 71. There is a slight cool breeze, but feels amazing. Not a real cloud in the sky.

I decided I need some Vitamin D, so I hopped in the car with my towel (sans shower) and drove the whole 10 minutes there.

It felt sooo nice, but once I sat down, I noticed a funky smell and saw a few dead fish. Perhaps there was a red tide? I stayed for about 10-15 minutes and enjoyed it.

Here's a quick video:

I was rockin' an RN t-shirt!

Happy Tuesday!

plans

So, one of my 2010 goals included starting grad school.

However, I may be delaying this goal until January 2011. Let me explain.

One of my goals when I entered the ICU was to become certified. For my own personal benefit (and the benefit of my patients, too), I want to be Nicole, BSN, RN, CCRN.. I kind of put that goal out of my head to start grad school because in order to become certified and take the exam, you need 1750 hours (about a year) in direct bedside ICU care. If I start school in August, then I would be just shy of this and I know I would not have time to study. PLUS, if I am going to apply to grad school, I think it would be beneficial to have my CCRN on my application as a boost to my acceptance.



In addition, if I want to start in Fall, then I need everything turned in by June 1st. Seeing as I have not been on my unit all that long, I still feel kind of weary of asking my manager/coworkers for letters of recommendation so soon. How can they write a genuine recommendation if they do not know how I critically think and act in situations? I want to give people time to actually trust me.

Based on this, my new goals:
-Spend the next year studying for CCRN. This is something I want to do. There is so much to know and understand; I know that studying would help to fill gaps in my knowledge base. I also think it will make me a better ICU nurse.

-I will be cutting it close with the one year mark, taking the exam, and applying for the grad program. All my info for the program needs to be received by October 1st. I believe I will have enough hours (1750) by the end of August or beginning of September. As you can see, this gives about a month, but I've read personal accounts that once you apply for CCRN, the okay to test was approved within 3 days. And since I am going to be studying for this months in advance, I think I will be okay.

Initially, I put this goal out of my mind because I thought, "well, who cares at that point? I will be in school and out of ICU and won't be able to continue my certification anyway..."



But to me, it isn't about the alphabet soup behind my name, it is truly the meaning of being certified in your specialty area. As an ICU nurse, I need and want to be the most competent nurse I am capable of being. I want my patient's, families, and coworkers to trust me. Most importantly, I want to trust myself.
Either way, I will still be working as an ICU nurse for the next 2-3 years once I begin school, so I'll still be getting a lot of experience, but I feel like giving myself this one full year of working would be beneficial to my overall goals. Plus, two full years of RN experience sounds a lot better on paper than one year and a half...



More benefits of becoming certified in my next post...

day shifter

So much for a nice, calm first time on day shift for me!

But first, I need to say that just my three days off to turn my body back onto a day schedule were amazing. I immediately felt like myself again. It was as if a light has been turned off and now it is on. I have motivation and energy and a spark! I woke up at 7 in the morning and I was so ready to go! I missed that.



Back to my first time alone on day's...it started off calm. I had two patients with the same exact problems.

Craziest of the day...they aren't allowed to give me three patients since I am still new, but they needed a 1:1 nurse for a new patient coming up from another ICU because he needed to be on a rotoprone bed! I have no training in this, at all. I knew my manager did NOT want to give me this patient, but she had no choice. These patients are SICK. My preceptor from orientation (aka: my ICU Mom) was like, "I cannot believe they are going to give you this patient. This is insane. I had to take a 10 hour class on this bed..." My manager felt that since it was at the end of the day, it wouldn't be a huge deal and she reiterated that she would never want me to have this patient for a whole shift. Not that I'm incompetent or anything, but I simply just do not have the experience.

After I gave up my patient to another nurse, I spent about 2 hours with the bed representative going over how the bed works. Wow, I feel like I don't need to go to weight lifting this week because I actually got a work out.

The bed looks like either a torture chamber or some sort of NASA device.


Numerous straps and buckles and controls.

I felt so anxious, I just wanted to go get the patient and bring him up! However, the bed representative was so helpful and reassuring. She kept saying how she would not leave me and I could call her day or night. Knowing that my shift was coming to an end, my fears began to alleviate.

My manager actually went up the open heart unit with me to help bring the patient down! The best part: I got report from my preceptor of my final semester of nursing school!! YAY!! She is so down to earth and similar in personality as me; sarcastic, etc.



In short, this patient was definitely sick. For those who have no idea what the heck this bed is or what it does: the basic premise is that it helps patients with severe respiratory issues, like ARDS. Basically, the patient goes into the bed (or...we put them in the bed) very tight, snug, and strapped in, and then the bed turns them upside down (prone) and starts rotating back and forth like a rotisserie. The purpose is to help perfuse other parts of their lungs and increase oxygenation to those other areas. That is the best I can explain it.


Here's a video I found on youtube. I have no association with this video, I am only trying to show what the heck it looks like:


I cannot give any info about the patient's diagnosis, but obviously their condition was sick if they were going into this bed.

The patient was obviously on the ventilator...with 100% FiO2. He/She also had the following drips: propofol, levophed, neosynephrine, xigris, D10, bicarb, potassium, protonix...I can't even remember what else! For lines, a swan, two central lines, and an A-line. Also, had a J-tube, G-tube, NGT, foley, Chest tube, JP drain, and blake...! In other words: sick.

Let's just say, it was A FREAKIN' pain in the ass to get the patient transferred, detangled, and assembled in the bed. Fortunately, the next shift had arrived, so the oncoming nurse (who happened to be my night shift preceptor) helped to set the patient up.

For this bed, all the lines need to be straightened (ha!) and placed in this wheel-device that turns with the patient and prevents everything from being pulled. All of that goes at the top of the head, while the foley, chest tube, and dignacare (or any fecal-management device) goes through the hole by the feet.

It took us about an hour and a half to get the patient mostly set-up. I left work at 6:45 (shift ends at 6), but I wanted to stay since we hadn't gotten to the point of proning him yet. The bed representative and I strapped the patient in. The freaky-ish part is this handle that you have to crank, which moves all of the cushions in towards the patient, squeezing them super tight. You need to turn the handle until you cannot anymore. It feels like you're going to just squish the patient to death!

When I left work, my legs hurt worse than they had in all of my life! I actually took an excedrin for them when I came home, and I never take medicine!




However, I can say that I did have a good day. Sure, I was nervous, but I learned something new. I feel like I need to be more confident and that is what I am going to work on. I need to prove to my manager and everyone else that I will survive on day's and everything will be ok! I think that majority of nurses trust me and think I am competent, but I just need the experience. For the most part, I want my manager to be comfortable with her decision to let me move to day's.

Click here and enter to win an ice cream maker!

back to the living

Third and last night at work tonight...and then on Tuesday I get to come back to a normal life! Yes, I am coming to day shift!~
Honestly, I did not like night shift at all. There were some pluses to it, like staying up later even if you had to work the next day, but besides that? Sleeping all day, eating at weird hours, driving to work when everyone else is coming home and winding down? ugh, so isolating!
And I never felt like I got restful sleep compared to my normal schedule. For instance, my body used to wake up at like 6-7 in the morning on it's own accord on day's off and I would feel great. Now? I wake up only because my alarm tells me and I still feel like I could sleep 12 more hours, despite the hours I already received.

I am nervous about working days' only because they are busier with rounds, traveling, and more family, but I think it is better to jump right into that sort of thing instead of hanging around on nights and getting used to  a slower pace.

A Day of Eats

I woke up this morning and decided to document my day of eats!

Normally, I would have oatmeal and peanut butter toast for breakfast, but I was fresh out of oatmeal, so I had to improvise.

I took the rest of my plain Oikos greek yogurt, the rest of the strawberries, mixed it all with honey, cinnamon, and Back to Nature Apple-blueberry granola.

And then of course, I had my peanut butter toast and a multivitamin. I just recently started to take a multivitamin, but honestly, I really don't "believe" in vitamins. haha. However, I like to donate blood and my HgB had been low the last few times, so I figured I would try a supplement. But then when I went to the store, I just figured...what the hell, I'll get a woman's multi. I am just skeptical about the health benefits. I truly believe it is the entire fruit or vegetable or WHATEVER as a whole that makes it so special, not the tiny micronutrients that can be picked apart. Anywho...

After lounging around like a lazy person, I finally went to the grocery store. As you can see, there isn't much in the vegetable or green department, but that is because of my CSA membership. I have tons of greens at home...

Lunch was left over home made pizza from yesterday. Here's some action shots of Mirza making it. He honestly makes pizza better than anyone. It always tastes amazing!!

Carrying on, I had one piece of left over pizza, a romaine/ mix of greens from the farm with chick peas, feta, balsamic vinegar, and evoo. On the side were Jalapeno smokehouse almonds from Blue Diamond. I love those little suckers. I couldn't finish them all though...

I spent the rest of the day running more errands (buying cat food), and then hung out at my mom's house for a bit. I honestly wasn't that hungry today. I don't know if it's because of my cold or what, but...

Before dinner, I had some more of the (un)healthy almonds...no picture.

For dinner, I had left over turkey bacon and I'm trying to use everything I have on hand, so I made a BLT and leftover apple-squash soup from the Clean Food cookbook. It was in my freezer from over a month ago and still tasted great...

There are absolutely no sweets in the house right now, which is just...disastrous, as far as I'm concerned, so I made some Butterscotch Brownies from the Betty Crocker Cookbook. Had about 4 little squares of these...

There you have it folks. That was my most random day of eats. Since I work nights, I will be up until about 3am, so I'll more than likely have more food before the night/am is over, like cereal..

I work the next three nights...adios.

ps:  Team Conan all the way

food

I finally managed to get my shit together last night and complete most of the tasks on my to-do list. The most important was making a menu of meals for the week and subsequent grocery list.
I cleaned out the fridge and started to feel bad. I was throwing away so much unused food, even from my farm, which just crushes me. Every time I throw something away, I just see money going into the garbage. I just imagine literally taking dollar bills, fives, and tossing them away. Due to this, I attempted to make my food list based on what I have in my cupboards and fridge already.

Days in red indicate I am working. Obviously, this isn't all I am eating, just my main meals. I don't include snacks or foods I may be eating on the side of the meals, like vegetables or fruits. Also, I don't normally schedule my lunch on days off because I just wing it. Work, however, is another story since I work nights. If I don't plan, then I am forced to eat at the cafeteria. That isn't necessarily a bad thing because the cafe has a lot of healthy options, but I'd rather not spend the extra money.


Tuesday
Lunch: left over pizza

Dinner:
Left over  apple squash soup
BLT sandwich 

Wednesday
Before work:
Left over meatloaf

At work:
Left over soup
Yogurt with fruit/granola

Orange slices 

Thursday
Before work: mizuna pasta recipe
http://www.ecometro.com/Community/blogs/portland_food/archive/2009/05/20/green-to-the-last-bite-of-mizuna-recipe-pasta-with-mizuna-and-walnuts.aspx


At work:
More pasta
-yogurt with f/g
-lara bar

Friday
Before work: miso soup with
Mushrooms, pepper, mizuna.

At work: left over’s.

Saturday
Dinner: pancakes with pears or apples sauce

Sunday
Black bean quesadilla recipe

Monday
Asian chicken wrap recipe
http://www.5dollardinners.com/2008/12/asian-chicken-wraps-with-steamed-snap-peas.html




Well, I'm off to start the day!

beneath winter skies

No Spend Month: Week 1

Week 1 of No Spend Month has been successful, if I do say-so-myself.



Working really cuts into my urges to spend and shop! haha.

To remind everyone, I only want to purchase essentials for the month of January. My goal in this whole process is to save and appreciate life without having to buy and consume mindlessly.

 Luckily, I have three movie gift certificates from work, so that is helping in the entertainment department.

We've been eating in, of course.  I had left over tomato sauce in the freezer, so we had that, among other things. I am realizing more and more how much food I do have at times when I think I have nothing! Creativity helps!

The challenge is to find fun activities that do not involve spending for the both of us. When I'm alone, no problem. I can read, surf the net, CLEAN, organize, etc. But when we're together, it's like...what do you want to do? I dunno, what do you want to do?
Anyone have this issue? Please offer suggestions on things to do. The problem is that I tend to sleep most of the day since I'm on the night shift schedule, so then we need activities to do at night...

I do have to confess though. I have spent on something that may not have been an essential.
.
.
.
I bought new pillows today.
But in my rationalized defense, my pillows were over a year old, flattened, and making it difficult to fall asleep. Also, I bought cheap-o ones from Walmart, and only two (I have four total on my bed!), sooooo we'll call it an essential.

---

In other news, I got the night off, giving me 6 nights off in a row! I don't go back until Wednesday, so Mirza and I can enjoy the rest of his vacation until school starts!