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NurseTwain

To Quarantine or not to Quarantine? This is Corona.

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I have debated on posting about this topic for several reasons. First, I am already tired about hearing about the coronavirus. Second, the world is in a state of panic over this pandemic and I do not want to add to the chaos. However, I am now writing because some facts and concerns need to be clarified using reputable sources.

What is the coronavirus?

There are many different strains of the coronavirus, of which 7 cause human illness. The one in concern today is the COVID-19 (coronavirus disease 2019), previously known as SARS-CoV-2.

What are signs and symptoms?

The most typical signs and symptoms in order of prevalence are fever, cough, and shortness of breath. The incubation period (time in which the disease creates symptoms) is anywhere from 2 days to 2 weeks. A majority of cases are mild and DO NOT require hospitalization. 1 in 5 people develop serious illness and around 2% of the cases have been fatal.

How do we test for the COVID-19?

Testing is increasingly becoming more available locally using respiratory specimens. Most testing is done officially by the CDC, taking 3-5 days for final results. If other respiratory pathogens are positive (influenza), then the COVID-19 is ruled out.

How is it treated?

There is no specific medication, cure, or vaccine approved for the COVID-19. Antibiotics are not effective because this is a virus, not a bacteria. Treatment is supportive- Tylenol, decongestants, rest, hydration, etc. People are advised to call the doctor’s office and if not severe, to remain home. Anyone who exhibits symptoms, but would not normally see medical care should remain home, even if they suspect the virus. Serious cases are those that require breathing tubes or assistance, and need trained hospitalized care.

Let me reiterate. Patients who present to the ED with mild symptoms are sent back home. Patients who cannot breathe are admitted into the hospital. These patients are placed on airborne and contact isolation in a negative pressure room. Health care professionals are required to wear a gown, gloves, N95 mask, and face shield when performing medical care.

Though no current medication has been specifically approved for the COVID-19, China has trialed the medication chloroquine phosphate (an anti-malarial) which was successful for SARS.

Who is at risk?

Currently, the risk for transmission is still low for the general population. High-risk populations include older adults, males, hypertension, diabetes, obesity, lung disease, and an elevated D-dimer (lab shown to be elevated in blood clotting disorders).

How to prevent the spread?

Handwashing and sanitization are the most important… why are we out of toilet paper and paper towels?

If you are sick and do not need hospitalization, stay home. The closures of schools and businesses is a way to “flatten the curve” of transmission. Large, crowded areas allow the reparatory droplets to spread through the air and infect multiple people. That is why avoiding crowds is important.

The COVID-19 is an airborne virus, so surgical masks are not effective. Surgical masks are only useful for very large particles, such as to prevent a surgeon from sneezing or coughing directly into an open wound.

Warm weather has not been proven to halt this virus.

What is the current situation?

As of March 14, 2020… Globally, there are 142,539 confirmed cases and 5393 deaths.

Final thoughts…

Yes, this is a serious pandemic. No, we do not need to panic. No, we do not need to stock up on unnecessary items like toilet paper and paper towels.

It is important to respond, not to react. Wash your hands, avoid large crowds, stay home if you are sick, and have peace over panic.

Resources

https://reference.medscape.com/slideshow/2019-novel-coronavirus-6012559

https://www.who.int/health-topics/coronavirus

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Until next shift,

Shania

Terminal Agitation

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Terminal agitation. I have never heard of this term before until my last shift. A patient I had a week ago, who was admitted with a fall, died today after being placed on Hospice care. The previous week, the patient was not oriented to person, place, time, or situation, and was very restless. She was able to communicate, however inappropriately. She constantly wanted to get out of the bed, and never went to sleep. She had dementia and I thought this was a progression of her dementia. I found out on this past shift that this agitation was actually her quick decline to the end of her life.

Another nurse on the floor worked in Hospice care for several years and had a hint that this was terminal agitation. The patient was seen to be picking at the air and stated that she was seeing her late husband. I have never encountered these signs before and contributed them to hospital delirium and her baseline dementia. I could not believe that the next shift I had, was this same patient who was now comatose and passed within 24 hours after transitioning into Hospice care.

Until next shift,

Shania

Criticals, Cultures, and Codes

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Today was a tough day from the beginning. At 0800, I got a discharge before I even completed the assessment or given any medications, then at 0900 I got a direct admission coming to an empty room, putting me at six patients. Throughout the rest of my med pass I got 3 critical labs, one unhappy family, beeping IVs, calls for pain medications, a positive blood culture, and telemetry notifications of abnormal rhythms. I finally got finished charting assessments, discharging my one patient, and admitting my new patient by 1430, which meant lunch time. Immediately upon my return, I got a second admission. Then, my extern ran to me and was concerned about our patient who was all of a sudden slow to respond to commands… that led to a rapid response call. Luckily, everything turned out to be fine with her and she slowly started to return to her baseline. By now I was at least an hour late on all of my medications, and got a call with a low blood sugar. Quickly, it was shift change at 1845 and I had yet to give 1700 medications.

Long story short, this was one of the worst days I have ever had as a nurse. It was a day where I barely had time to complete my checklist, could not build rapport, or read any progress notes. My motto of the day was “just keep swimming” and I was just treading water.

Until next shift,

Shania

Nurse-physician communication

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The first time I ever got yelled at by a physician was my first month off of nursing orientation. The patient’s chart was “r/o stroke”. One of the core measures for stroke patients was to provide a handbook and educate them on stroke diagnosis, prevention, and treatment. Apparently, no one had told this patient that we were ruling out a stroke, and as I began my teaching, she got very upset. The physician walked into the room and was flooded with questions from the patient and family about her stroke. The patient was found not to have a stroke, but was not told of any of this. The physician found me in the hallway and immediately starting yelling at me and told me to not tell someone that they have had a stroke. I pointed out on the chart that it clearly stated that they were ruling out a stroke and to provide education. The physician was not even aware of this. I walked back into the patient room and they were appalled by how this doctor had treated me. They ended up leaving AMA because they didn’t want to be in a facility where the doctors treated their nurses like that..

The Chief Medical Officer found me later in the day and told me that the physician actually felt bad for yelling at me because he was having a hard day.

Communication is extremely important in healthcare, however patient surveys often rank this category as in need of improvement. Communicating with doctors can seem intimidating, especially as a new nurse or one who is new to the unit. The best doctors are those who are not only knowledgeable, but personable, make efforts to communicate with nursing staff, allow time for questions, and those who are patient. Unfortunately, many doctors do not act this way. Below are some tips to utilize when contacting the physician.

  1. If you have even a slight feeling that something is wrong, contact the physician. You see them for 12 hours/day. They are only in the room for 20 minutes.
  2. Use SBAR– provide the situation (why are you contacting?), background (labs, dx, hx), assessment (lungs, bowels, VS, etc.), recommendations (what does the patient need?).
  3. Be confident in yourself.
  4. Remember that you do not work for the physician. You work for the hospital.
  5. You are the patient advocate.

Until next shift,

Shania

Please, do not wish to die

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Our God is a way-maker, miracle-worker, promise-keeper, a light in the darkness. God will put you out of any situation no matter how wide, how deep, how high, or how low it may be. It breaks my heart to see hurting people believing that ending their life is the only solution.

Suicide is the 2nd leading cause of death for ages 10-24 year olds and continues to increase yearly. Speaking with suicide survivors actually reveals that a majority of them regret their decision to take their life and are thankful that their attempt was unsuccessful.

Patients so often state how “they want to die, they are a burden to their families, they are terminal anyway.” Nurses make comments after a long day such as “kill me. Shoot me. etc.” Our language has power, and we may not realize the hurt someone actually feels behind their “joking” words.

Life is so so beautiful. If you don’t see it, be around those who do. Engage yourself within nature and a healthy community. There is breath in your lungs. Joy comes in the morning.

Please, don’t wish to die.

Until next shift,

Shania

Suicide resources:

suicidepreventionlifeline.org

1-800-273-8255

When you don’t want to let go

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Nurses always say how nurses are the worst patients. One may think this to be silly since nurses can relate to the work, however it has proven to be true more often than not. Emotions run high in the hospital and having a nurse either as a patient or a controlling family member often proves this statement to be true. From every safety step to every decision, the off-shift nurse at the bedside watches the primary nurse’s every move. And when the patient is actively dying, the nurse family member is even harder to handle.

Watching a patient decline, converting them to comfort measures, and switching them to hospice is one of the many tough aspects of nursing. When this patient is a family member, the decisions become harder to make as the wishes of the family conflict with the wishes of the patient and/or the patient’s best plan of care.

I recently had a patient for weeks who originally presented with an ileus and GI bleed. She was NPO for two weeks and connected to an NGT with suction. Throughout the stay her bowels began to function, while her kidneys began to fail. She became sicker and sicker by the day until it did not seem like she would survive the weekend.

She was originally having full conversations and working with PT, then quickly progressed to 1-2 word sentences and was using all of her energy to breathe. Her daughter was a nurse and was active in her plan of care. Throughout this decline, she ordered every lab and test to be completed even if it did not seem to be in the best interest of the patient. Her mother appeared to be actively dying and the daughter stated how she knew in her brain that what she was ordering was probably irrational, however her heart could not let go.

One shift the patient woke up enough when the doctor and daughter were communicating to clearly state her wishes. I will never forget this moment. It was as if she took all of her energy to tell her family that it was okay. She looked at her daughter and said, “Please don’t cry. It is okay. I am ready to go home.”

Everyone in the room started to tear up- daughter, MD, and me included. The patient had the biggest smile on her face. This brought comfort, closure, and the next steps in the plan of care.

When many of the previous nurses complained about the controlling daughter, it is moments like these to make me take a step back and empathize with her feelings. All she was trying to do was ensure that we were providing the best care and holding onto any last hope to prolong her mother’s life. Anybody would react this way, not just nurses.

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615-856-8181
shania@shanialynnvo.com