justify the things you do

Today was so good.
Let's start with dinner! I made some lasagna spinach rolls up, inspired by this recipe, which I completely tweaked and made my own.

Mario Batali=hero! This sauce is great: all basic ingredients you can pronounce, short list, no preservatives or extra sugar. Just pure food.


My mixture included whole milk ricotta. Now, normally, I WOULD go ahead and use the part-skim variety, but then there are times when I just want something that is as close to the source as it can get. All of those fat free and low fat food items are much more handled and processed. That isn't to say I don't utilize them! Because I do! I actually buy fat-free organic milk and yogurt.

However, here is an interesting passage from Michael Pollan's In Defense of Food:

Page 153-154:

Very often food science's efforts to make traditional foods more nutritious make them much more complicated, but not necessarily any better for you. To make dairy products low fat, it's not enough to remove the fat. You then have to go to great lengths to preserve the body or creamy texture by working in all kinds of food additives. In the case of low-fat or skim milk, that usually means adding powdered milk. But powdered milk contains oxidized cholesterol, which scientists believe is much worse for your arteries than ordinary cholesterol, so food makers sometimes compensate by adding antioxidants, further complicating what had been a simple one-ingredient whole food. Also, removing the fat makes it that much harder for your body to absorb the fat-soluble vitamins that are one of the reasons to drink milk in the first place.





But for this dish, I wanted something untouched, for the most part. It had ricotta cheese, a shredded cheese Italian blend, organic portabella mushrooms, and s/p. I used whole wheat lasagna, of course!




They were so cute! A before and after going in and out of the oven!




mmmm cheesy and bubbly..








On the side we enjoyed toasted Ezekial 7 grain bread. A bit on the expensive side, but worth it.



The rest are some random pictures we took before going out for dessert!











We knew exactly where to go for dessert!
Frida's Cafe and Bakery!






Stay tuned for an update in the AM about the jazz concert we attended!

it's all greek to me!

Not a whole lot to report on the ICU job front. I've basically been in awe by how sick people can get so quickly. Sepsis=scary! I'm also in awe by how quickly they can also turn around and get better all because of great care. I love it!

I don't work again until Wednesday, but I have two labs in a row on Monday and Tueday.
Monday is apparently a lecture on diabetes and Tuesday will be the actual lab portion with stations. The CCIP instructors said the diabetic lecture is something we will not soon forget, as it is taught by someone who is quite enthusiastic, getting the crowd involved, etc. We'll see...;)

Mirza and I went out last night to a greek restaurant (we also went last Friday too!) and it was great as usual. We started with an appetizer of hummus with pita. The pita was warm and toasty, but soft. Last week we both got huge dinner plates, but yesterday decided to go for sandwiches.
Unfortunately, I didn't have my camera to photograph the deliciousness, but I got the portabella mushroom sandwich, which consisted of: portabella mushrooms, onions, red peppers, tomatoes, and A LOT of taziki sauce stuffed into a gorgeous pita bread! I LOVE taziki sauce. I also got a side of Mediterranean pasta salad.
Mirza got the same thing, but substitute the mushrooms for lamb souvlaki and the pasta salad with french fries!:)
I'm glad that I went with a vegetarian entree. I didn't feel weighed down by the meal like I would have if I had chosen chicken or french fries:/
We also talked about how if and when we finally get a chance to travel, we probably wouldn't even care about seeing all the famous landmarks, we'd only be interested in eating. Because really, who cares about the coliseum when you have amaaaaazing food!?

Schedule for today includes working on my endocrine modules, 11:30 yoga, cleaning, food shopping, and hanging out with Mirza. He teaches guitar all day Saturday, so it gives me time to catch up on this kind of stuff!!

I leave you with the ferocious Max!

1:1

CCIP is moving along quickly! We've finished the cardiac modules and are now doing hemodynamics. Luckily, my nursing program was excellent about teaching this, so it isn't completely foreign to me. Also, since we did have Sim Man at school, we had a lot of opportunities to look at monitors and waveforms, etc. That being said, I've been in tele the past year and did not need to know any of this information, so there is still a learning curve. Everyday I learn more and more, yet it seems the more I learn, the more I realize there is even more stuff to know *slaps forehead*...

The past two days were a definite learning experience! Halfway through the day on Wednesday, our assignment changed from 2:1 to 1:1. The 1:1 was originally admitted to the hospital for an elective takedown colostomy, ventral hernia repair, and ileostomy insertion. He then went septic and was transfered to us and subsequently went into respiratory distress and was placed on the vent. I won't get into the details of his history too greatly, but he needs dialysis 4 times per week. He became a 1:1 assignment because we started CRRT (Continuous Renal Replacement Therapy) on him.

The last few days have been good because I'm getting "used to" titrating drips, which is not something nurses do on the floors. For example, he was on neosynephrine because of his hypotension. As the ICU nurse, we have to increase or decrease the drug to effect the patient's blood pressure and get the numbers we want to see. I love this part of ICU nursing because I feel much more autonomous! He was also on an amiodarone, propofol, and heparin gtt (drip).

As for the CRRT, it was difficult figuring out the numbers and such, but I THINK I got the hang of it...


(our machines look way more modern than this. We use NxStage)




In other "exciting" news...they started a Monthly nursing journal club at work. Each month we will get together and choose one nursing journal research article to discuss. We had the first meeting yesterday to discuss logistics of the meetings, and we went over an article from Critical Care Nurse regarding Rapid Response Teams. Here's the article:
http://ccn.aacnjournals.org/cgi/content/full/29/3/66

My ICU has had a RRT since 2004. I can't wait until I'm "competent" enough to be the one who carries the beeper and feel like a bad ass when I go up on the floor and help the nurses, haha!!


A long way to go...

Poor Taylor Swift!!! Kanye West sucks, for real.

Sunday dinner!

Man, so after all of my decorating (ha ha) today, I was feeling totally lazy. Mirza came over after the gym to see my apartment and he liked it. We almost ordered a pizza because I was, "waaaah, I don't want to go to the store!!" But I said, "No, we can't order pizza because then I will just feel dirty, disgusting, and guilty after..."

So, he left to go shower/practice and I headed to the store...

I decided to try THIS!!!


HOLY MOTHER, I am glad I did. I honestly didn't think the flavors would be so awesome, but everything just pops. Roasted veggies are...the bomb! yes, I said it, the bomb.

Roasted Vegetables on Creamy Polenta:

I used: 1/2 zucchini, 1/2 summer squash, 1/2 tomato, 1/4 red onion, 1/2 eggplant, 1 portobello mushroom cap, 1/2 red bell pepper...















And of course, I spruced mine up with some feta...because, you know, everything is betta' with feta!

Transforming my living room

So, for about the last year, I've lived in my lovely, but very blank and undecorated apartment. I never felt brave enough to buy any artwork for the walls, nothing ever felt right. Well, this weekend, I decided it was time for my apartment to stop feeling so cold. As I've heard Oprah say numerous times,"Your home should rise up and greet you." Cheesy, but I love Oprah.

This is the before picture taken last October when I moved in:


Everything has stayed that way pretty much for the entire year, except I had different pillows on the couch.

And this is what I did this weekend (I'm not done!):



New rug from Ross: $24.99!!





Pillows came as a set of two from Kohl's...were marked down from $39.99 to $17.99 TOTAL.
And the metal art was from Marshall's for $45 total!





Grand total for revamp: Less than $90...
I still need something on that far wall. I am thinking some sort of shelving and a mirror. We'll see...
Hey, I'm no interior designer, but it is definitely better than before.


Edit:
Ok, here are a few experiments:



I definitely like the flower one more...






hmmmmmmm

September 11th.

9/11



To choose unbelief is to choose mind over dogma, to trust in our humanity instead of all these dangerous divinities. So, how did we get here? Don't look for the answer in story books. Imperfect human knowledge may be a bumpy, pot-holed street, but it's the only road to wisdom worth taking.

CHEST COMPRESSIONSSSSSSSS

I did chest compressions today!! First time EVER!! So exciting and scary.LOVED IT!!

I love my job, I LOVE ICU!!

Results of oatmeal experiment!

So, what were the results of my oatmeal experiment?

Well...









I must say, it turned out pretty good. I did end up adding a pinch of salt and sugar to my single bowl, but overall, it was good. There wasn't a strong flavor, it was mild, but I wouldn't call it bland either. Either way, it rescued me for the morning until I was able to go shopping and buy oatmeal!! Also, I added a little bit of coconut oil to the mix.
And I enjoyed it with some delicious raisin cinnamon monk's toast
(it was the only raisin cinnamon bread I could find without HFCS or other weird things at Publix).

Experiment

So, I just realized that I am out of oatmeal for the morning. I eat oatmeal with peanut butter toast literally every morning for breakfast. Yeah. I'm boring, but it's like...I can't live without this combo.
The solution: overnight steel cut oatmeal in the mini-crock pot. Since I'm in dire need of grocery shopping...

as evidenced by this empty fridge...

"How embarrassing - a house full of condiments and no food"


...my ingredients are quite limited. I literally have no fruit. But guess what I DO HAVE??? Yes, that's right, Amazing Grass Chocolate Green SuperFood Drink Powder!!! In a single packet!!


I tossed it in the crockpot with my oats, water, some vanilla, and cinnamon and I will let you all know the results of my hopefully tasty and nutritious breakfast. That or I'll go hungry because it tastes like ass...

Clinical days 3 and 4!

Wed and Thursday were my two "clinical days."
The day begins at 4am when my alarm goes off! They start promptly at 5:30, which for some may be difficult, but I love it! I know that in a few months I will be doing nights until I can get on days, but getting home at 6:30 instead of 8 is magnificent!
Wednesday was honestly kind of boring. Our two patients were mostly stable and could have potentially been medical or tele patients. When I spoke to Mirza on the phone, I was like, "Yeah, today is kind of boring ...nothing really crazy going on with my patients." To which he then replied, "so basically, no one is dying, so it is boring." haha so sad, but true...

Pt #1: Pt transferred from the floor to have aquapheresis
Pt #2: Pt who sat in bed for 2 weeks and as a result, had funky electrolytes and other issues.

Aquapheresis is new to this unit, but it is really neat. Here is the website: http://www.chfsolutions.com/


I took the course and got a little certificate. But basically, it is SORT OF like dialysis, but you can use a peripheral or central site. It takes blood out of the body and before returning it back, removes a set amount of excess fluid into the drainage container. The patient gets to keep their other electrolytes, plasma, albumin, etc. The system is geared towards CHF-ers mostly. Love it!!

Besides that, the day was slow. However, it was nice because the nurse I was working with went through all the books on the unit and talked about scheduling, vacations, floating, etc. This was helpful because sometimes this stuff never gets explained well during orientation. It is kind of like "drive-by" teaching and then you forget, but she literally sat down and went over the essentials.
Get this: I never have to float to med-surg or tele!! They only float between the units!! AAH LOVE.

---


I'm going out to lunch with a friend from nursing school today and enjoying my 4 days off. I switched my schedule from Mon and Tues to Tues and Wed, so I could have more time off to be with Mirza and study.

Sim lab #1

This morning until noon was our first "Sim Lab." Our hospital education center has the Sim Man, which from the website states: SimMan® is a portable and advanced patient simulator for team training. SimMan® has realistic anatomy and clinical functionality. SimMan® provides simulation-based education to challenge and test students’ clinical and decision-making skills during realistic patient care scenarios. SimMan® includes well-proven software and an interactive technologically advanced manikin allowing learners to practice the emergency treatment of patients.

source:http://www.laerdal.com/document.asp?docid=1022609



Basically, he responds to the things you do to him like a real human. We used him during nursing school, too. It kind of creepy how he responds to things. For instance, even his pupils react to light. Freaky!

Anyway, they call him Max at our hospital, which makes me laugh because that's the name of my cat!!


We are broken into 4 groups with about 4-5 people in each. Today there were different stations for us to visit, half hour each.
First, we watched an AHA video on airway management, ambu bags, etc. We practiced compressions, etc. The program is set up so that if you don't have ACLS, you will receive bits and pieces of it over the next few months and then can become certified. I already am, but again, love the review. Especially since I have never been in a code, so the more practice I receive, the better.
Second, we went to the actual Sim Lab and listened to breath sounds; it was more of an introduction to "Max," so we could see how he normally sounds and then distinguish different adventitious sounds, which the instructors control through the computer. We then went over chest tubes and discussed how the next sim labs will operate. For instance, next week will be a code blue scenario. We'll each pick a number and it will determine if we're the team leader, drug pusher, compression person, etc. Eventually, we will all get to do each role.
The third station for today was on tracheostomies and the different kinds, etc.
Finally, we did an ABG "quiz," but we did it as a group and it was a very nice review!!

At the end, we all got together and did a little game of "beat-the-clock," which is kind of similar to the show "Password" where you get a word and then try to get that person to say it. This week was all about respiratory. My team came in 3rd, haha! It was hard and nerve-wracking, but a fun way to end the day. It was also a learning experience, too.

Our next modules cover cardiac. They give us two weeks for this since it is the most intense and difficult.

Day 2.

My second day in the unit was even better than the first!
Nothing crazy or too exciting happened, but I loved the day. We had the same two patients: male, GIB and the female with H1N1 on the ventilator.
I got to do trach care, which involved quickly unhooking the patient from the ventilator and carefully removing and replacing the inner cannula. It was kind of intense because the patient is coughing (but no sounds) up a lot of secretions and the damn ventilator is alarming, but I did it!
My preceptor also said she thinks I will do great in the unit. Numerous times she was like, "wow, I am having a great day because you're doing everything!"
There is still a LOT I need to learn, but I'm confident that everything will turn out great.



Mirza said I seem happy and lighter. So true.

I'm working through my ECCO modules and enjoying those. It is a nice review of the body systems, but from the critical care perspective. And I'm finding that I learn better when I am not under the stress of some huge life altering exam (ie--school exams, finals, NCLEX). Of course, I need to know this information, but I WANT to know it and understand it, so it is exciting!

i LOVE IT

Quick update, more thorough one tomorrow:

HAD A GREAT DAY! I think I am going to LOVE my job...no, I know I will definitely LOVE IT a lot more than the last!! Everyone was so nice and I find the nurses in the unit to be much more professional. No one seems catty or rude. Everyone is there to help.
We had two patients, both of which were on the verge of dying just days ago, but are much more stable now.
Pt #1 is a woman with swine flu!! only in her 40's. On the vent, but they put in a trach this afternoon. She almost died a few days ago.
Pt #2 was admitted JULY 4TH...that's a long freakin' time. Came in with GIB. Was intubated/extubated numerous times, CRRT, the works...is now on RA sats like 98%! He had a lot more going on, but yeah...

back tomorrow, excited!

PS: I absolutely LOVE LOVE LOVE that my shift ends at 6pm. I am used to 7-7 and don't get home until 8pm. Well, I was home at 6:35 today. AMAZING!!! And waking up at 4am was not an issue for me at all. I went to bed between 830-9pm. It really makes a difference to get home so early.

nerves

First day in the unit tomorrow!!
I'm a lot more nervous than I thought I would be...
I'm just worried, hoping the nurses and staff will be nice and welcoming..aaah, first days suck!!!
Plus, I'm nervous about going to bed. They start at 5:30, so I'll be awake by 4.

First day!

Got out early from orientation today! wooo!
So, basically we went over how the program runs: 10 weeks, lots of online modules, clinical time, and sim lab time. Got my book!! We're using this:

Thelan's Critical Care Nursing



We had to take a BKAT (Basic Knowledge Assessment Test), which they told us most people do not do well on at all. In fact, the majority get in the 60's to low 70's. And they expected this since we hadn't received the content yet. The exam was 100 questions and was all clinical stuff. I got 77%!! The instructor said I did "very well." That felt good. Apparently, we take the same exam at the end and they expect us to get at least 15 points higher. It is mostly just to gauge how THEY were doing as instructors, as well.

The day also consisted of a video from Dr. Laura Gasparis Vonfrolio on interpretation of ABGs since there will be an exam on that next week!

What else....what else? Ah, we watched a video from American Heart Association on the roles of different people during a code, which I had already seen since I took ACLS, but it was a good review.

Finally, we covered airway management and RIS (rapid intubation sequence). All of this included intubation facts, different airways, and the drugs for intubation, like sedatives, paralytics, etc. Fun, fun, fun!

I also met with my educator from the unit and she gave me my schedule. Looks like I'll be starting on Wednesday and Thursday. The cool part is that for the next two months I will not be working on the weekend!! Yay, this is awesome because of Mirza's schedule.

First module: pulmonary! Better get to work.

The end. The Beginning!

Halfway through my shift yesterday, the charge nurse presented me with a cake that said, "Good luck Nicole!" I thought that was so sweet. I honestly did not think anyone would even care.
And then my manager called towards the end of my shift (she doesn't work the weekends). She said, "I just wanted to apologize for not coming in to say goodbye, but I have the flu. I wanted to congratulate you and wish you good luck. You are a GREAT nurse and I know you'll go very far in your career. Thank you for working so hard." Aw, she was quite sincere.
---

Tomorrow is orientation from 8am-1630. We'll be in the education center, which is in an entirely different city, so I'm not on the unit quite yet. I'm anxious to see how the program is run exactly. I'm also wondering when I will step foot on the unit. I hope it isn't Tuesday. I think I need a moment to breathe (hyperventilate) and gather my thoughts...

eeeee!

last day tomorrow!!

Tuesday was my one year anniversary of working on my floor! The floor gave me a company card that said thanks for my dedication, etc and another one of those 10 point passes redeemable for online gifts (I got another movie ticket).
And now, tomorrow is my LAST DAY!

What is awesome and strange is that it will be my last time of taking care of 4+ patients again...EVER! I mean, sure there is a chance in my career as an ICU nurse that I could float to med/surg, but still....EVER!!! 2!~! aaah.
Words cannot describe the feelings...everything from scared shitless to excited beyond belief. I feel like I'm finally going to be doing what I've wanted to do! Besides moving to the unit, I'm also moving hospitals (but staying in the same organization). I'll be transferring from a 300 bed facility to 800...both magnet hospitals. I feel comfortable at both hospitals, but it will be difficult to have to relearn all the new doctors and phone numbers, staff, etc.

The main thing is that I hope I can enjoy it. What I mean is that for the past year, while I certainly almost always gave 100% at work and focused on learning how to be a nurse and how to be a damn good nurse (in my own eyes, hehe), I still felt as if, "ok, I am here for 12 hours, I need to do my job, make it through the day, and then go home." I was not living my job. I was only thinking about what my next steps would be, which has always been critical care. It was as if I was in some limbo.
Now that I'll be doing what I had always wished for, I hope I am able to "sit back and enjoy it" in a way; to truly LIVE MY JOB CAREER PASSION.
I'm only afraid that I will continually be looking to the future for the next step and goal, like school. I put a ton of pressure on myself to go back to school as soon as possible. I also feel pressure from former classmates who are always asking on facebook who is ready to go back...and I know many of them will be! However, I don't want to keep rushing in life. I just wish I could ENJOY this time and let school come when it feels right. Truly, I want to be comfortable as a critical care nurse; I want to become certified, everything.
Also, I don't want to only go back to school just for more money, or "to get it over with," since I'm 24 and feel like I'm getting too old. I am the kind of person who wants to get my master's finished before children, etc. Not to mention the new 2015 guidelines that will require ARNP's to have a doctorate. I'd rather finish before that mark. But who knows what life will bring anyway? Maybe I'll go back for CRNA?

In any case, life feels like it is beginning!

I'm currently reading

...a compilation of nurses' stories from the ICU...for a little inspiration!

The night after I work two in a row is always hard to sleep because my dreams are so stressful!! For instance, right now it is only 5:45 am, but I am awake since I couldn't stop dreaming about real patients I had yesterday but with dreamt up critical lab values that need an MD call. I dreamt my 50 year old woman with a SBO had a Na of 142 (real) and that it dropped to 127 (dream) and that her H/H went from 10.5/whatever to 6.8 (dream).
Can't I just have some peace here!

Grad

One year ago today I became a college graduate!
aw.

Recognition

I think that I will try hard to always remember how good it feels to be recognized for doing a good job. Even small things really do make a difference. For example, yesterday I was floated (big shocker) to med-surg. It wasn't horrible, but I definitely ran the entire day. Also, the fact that if you want to sit then you need to go to the nurse's station really doesn't make it any easier on the back or knees after 12.5 hours. Besides that, I had a decent day.
What really made me happy was that before the shift ended, the charge nurse walked over and handed me this VIPGift Pass for 10 points. This is a site my hospital uses to reward nurses and other staff at the holidays and things of that nature. The points are reedemable for gift cards, household items, electronics, etc.
She wrote on the paper, "Nicole-You were fantastic. Thanks for all your help!"
I mean, it is so simple, but so appreciated. Sometimes you just feel like no one cares what you do because it is your job, but I felt it was nice.
And I got a free movie ticket out of it:)

Boston

Hi everyonem,
I have not dropped off the face of the earth officially. I am currently in Boston visiting my sister and nephews! Mirza and I will be catching the plane back to Tampa tomorrow night.
Updates to follow!