How I cured a patient with an alcohol wipe, and the latest on “The Project”

A few days ago a patient came in upset about her arm after being in the hospital for a couple of days. She is a lovely older woman I had seen a couple of times before, so when the nurse told me the patient’s arm was swollen, and “fibers” were coming out of the area that the IV had been, I was worried. I tapped on the door and went into the exam room. She was sitting in the chair with an anxious look on her face, holding her left arm out stiffly.

When I looked at the arm, I didn’t see any swelling or bruising, no redness, nothing. She pointed to her forearm and said “Look, see this dark area, there are fibers coming out of it! What is wrong, what could do that?” She was visibly upset. I looked where she was pointing and saw the distinctive square outline of tape marked in leftover adhesive. Little bits of thread and lint were stuck on it. ….Oh.

I explained to her what she was seeing. “Do you mean that all that is, is DIRT? I am so embarrassed, my husband will laugh at me!” After cleaning off the adhesive with an alcohol prep pad, I suggested that she could tell her husband she had a bad case of adhesodermatitis, but we were able to treat it successfully. She liked that and left with a smile.

So, the first two parts of the project are done: the matrix and the evaluative summary (review of literature). The entire floor of my study room and all available horizontal surfaces are covered in articles and studies duly printed on my printer after a “literature search” on all of those lovely databases. Most were rejected, 20 remained and were loaded into the matrix. Did any of you see that movie? I felt like one of those people in the little pods by the time I was done. My entire world had shrunk to the size of my laptop screen, the actual reality world disappeared. My husband forgot what I looked like and my dogs gave up on presenting enticing toys for me to play with.

The end result of all that study? I found out that the available research about diabetic foot ulcers and preventive education basically sucks. I barely managed to get enough info to do the project. Hope I still get a decent grade.

Actually,  I lied about the dogs not giving me toys. One of them thought I might be tempted with a mouse. Here I am, in crisp white lab-coat, ready to go out the door to clinical and…..

Yikes! But he was sooooo proud of himself!

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The next semester approaches

So, Christmas is done, the presents opened, Christmas dinner consumed, friends and family visited and partied with. Only New Year is left and then back to clinicals. My dogs have enjoyed the extra treats, opened their presents, removed squeekers from the stuffed ferret, though the hedgehog still has its grunter intact. They still look longingly at the tree, hoping for more goodies.

There is more....isn't there?

 

I am quietly sitting in my favorite chair, working on an appliqued quilt block. The Fitzgerald study book is laying on the table, causing little rushes of guilt about not studying. I am going to be seeing a whole new type of patient (adults) and am getting the usual feeling of “oh crap, I don’t know anything” again.  After the last rotation in pediatrics, though, it is a little less. It is nice to realize that there is still some room in the old brain to acquire knowledge and experience, and that after an initial period of insecurity, things will look up. I am told that my new preceptor loves to teach, so I am looking forward to a rewarding experience.

There are only eight months left until I graduate. I am hoping to get a couple of trips in after graduation and before I start a new job. My family is in Europe, and one of my best friends, so a trip to Denmark and Holland is planned, and I would also like to see some friends in Pennsylvania and a friend in New England who has a puppy from one of my dogs.

I can actually believe I will be getting a life again. And a career that isn’t a disease (hopefully). Being an RN has been a wonderful thing, but health care going the way it is, the jobs were getting tough to do. Too much paperwork, not enough respect or time to be with patients and actually do nursing. When I graduated nursing school, RNs still made beds, bathed and fed patients. There was an enormous amount of clinical information you could gather from those simple tasks, which I felt were vital to doing a good assessment on your patients. I feel sorry for RNs now, who are responsible to assess their patients with information obtained from “patient care technicians” with a few weeks training, or a quick run in and out of a room to pass meds. That is scary to me. I hope that this trend reverses, for the sake of the patients and the overstressed nurses trying to care for them. I hope that hospitals and nursing homes realize that the heart of their service is nursing, and treat the nurses with the respect they are due and allow them to do their jobs by giving them reasonable workloads and time to do their jobs properly.

Hopefully, being an NP will be different, with some of the same paperwork headaches, but with more responsibility, challenge and patient care focus. I am looking forward to a happy and rewarding career with the opportunity to use my nursing skills to the fullest. I don’t plan to retire until I physically can’t do the job anymore, and hopefully that will be at 99 years old.

Now, I just need to get through the next eight months, and pass my certification exam…

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Dogs get rashes, too.

Recently, one of my dogs kept getting a rash on his belly, in his armpits and under his chin. He kept rubbing his face on the carpet until he wore patches of hair off his ears and around his eyes. I was really puzzled by this, he never had any allergies before.

So, I put on my diagnostic hat and started thinking about it. The rash on his belly was red and especially bad under his armpits, the skin around his eyes looked atopic (like eczema) and it was all obviously itchy as he kept chewing at his feet and belly and rubbing on the carpet and shaking his head a lot. The rash was obvious as this dog always sleeps on his back…

Lookit my rash, mom!

I tried to think of what was new in his life recently…..food not changed, no new toys or treats…oh, yes, new treats. But, it seemed so local, this rash, only on his belly and face. Food allergies erupt all over. Flea allergies (not that he has any) show near the base of the tail. Then I noticed an area in the yard with a ground cover called Oyster plant, we had put it in recently and it was doing nicely. Hmmm….A little research on the internet, and I had the answer.

The culprit

Oyster plant, otherwise known as Moses in a Basket and Boatlily, or taxonomically as Tradescantia bermudensis, turns out to be poison ivy for dogs. I saw that the bed had been enthusiastically plowed in the hunt for lizards and other interesting little animals that Elwood loves to find. Too bad, the plant was so pretty and made such a good ground cover for the area. Oh well, the plants were dug out and tossed into the yard waste bin to be hauled away.

Maybe ferns would look nice in that particular spot, but, I wonder if little ferns are toxic to dogs. I will definitely look into it before planting them. Perhaps I should look up the other plants we have in the yard, too. You never know.

Elwood is doing fine after a short course of Benadryl.

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7 days to clinicals

There is one week left before my clinicals start. I am trying to arrange coverage at work for the days I will be off, setting up the parameters in the computer program we will be using to log our cases and hours, emailing back and forth with the office manager at the pediatric office to set up a preliminary schedule.

I am not sure yet how many actual hours/days are needed to meet the requirements for this rotation. It seems we are to log 240 hours in 14 weeks, but can’t be sure until the class opens and I can read the syllabus. I also don’t know how many patients we are expected to see per hour. Here’s hoping that the initial expectations are not too crazy…

I bought the Fitzgerald review book for Family Nurse Practitioner, but am thinking of adding the pediatric one to the pile as well. The question and answer, followed by a discussion format of this book is working well for me. It is amazing how many questions I actually know the answers to, this is a good sign. Maybe the boxes in my brain are accessible after all… 

Looking forward to actually dealing with real, live patients is still scary, but also exhilarating. Finally, to be able to put the studying to some use. For me, doing is always better than reading anyway. If I do it once or twice, it sticks better than days of reading and re-reading.  Even if that reading is done sitting on the deck overlooking the forest at the cabin we like to rent in upstate South Carolina!

One week on a nice, quiet vacation does wonders for one’s aged and overflowing brain. It is kind of like a defrag on the computer. The rest and slow pace help to reorganize the bits of information in a more coherent manner, throws out the useless stuff and generally makes those neurons fire more efficiently.

We did learn something while in South Carolina, turtles hide under leaves.

My husband loves turtles, and one afternoon as we were driving around checking out the countryside, we saw a box turtle in the middle of the road. Worried it would get squished by the next car, we scooped her up (Yes, her. My hubby can tell the sex of a turtle by gazing into their eyes, is that weird?) and brought her back to the cabin so we could let her go in the woods far from the road. Our dogs were quite excited, Elwood wanted to open it and see what was inside (didn’t let him, of course) and Jake just stared and stared at it. Back at the cabin we let her go, and the boys just had to watch from the window.

Where did she go?

After that, when we went for walks in the woods, Jake scouted all around us, sniffing in the leaves. Now and then he would pull back some leaves and proudly show us a turtle. He must have found five or six turtles in two walks! I figure either Jake saw we liked turtles and found all he could to show us, or he was looking for the one that “got away”.

Upstate South Carolina is a super nice place, friendly people, beautiful country and neat little towns and cities. Greenville is fantastic, with a park boasting a waterfall right in the middle of town! We love the area and vacation there often.

All in all, I am ready to go! Rested and rejuvenated, functioning at peak middle-aged level…

PS: If any family practice in Upstate South Carolina happens to be reading this blog and needs a nurse practitioner in about a year, you  may respond at any time!

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